Medical Management

Case Management

Case Management provides a collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet a member’s health needs, using communications and available resources to promote quality, cost-effective outcomes.

Members may be selected for Case Management based on criteria that address various demographics, including but not limited to: age, psycho-social and economic status, support systems, diagnoses, and/or complexity of treatment plan.

Cases may be identified through utilization reports, health promotion activities, claim activity reports, complicated in-patient admissions, and practitioner, provider or member authorizations.

Case Management is conducted in collaboration with the practitioner, supports the practitioner/member relationship, and promotes adherence to an established treatment plan. Members are notified of their selection for case management.