Care Management
Care Management looks at a patient's risks, needs, and goals and then puts together an action plan to get to the outcome the patient wants.
The Care Management team consists of clinical and nonclinical staff in the following areas:
- Case Management
- Disease Management
- Utilization Management
- Special Health Care Needs
- Member Review and Intervention Program (MRIP)
The Care Management team tries to:
- Be the patient's advocate.
- Coordinate services to the patient.
- Track how well the care plan is working to maintain the patient's health.
- Support the relationship between the patient and providers.
Community Health Plan can help to support high-risk moms during pregnancy or postpartum recovery. If you need this support, Case Management will keep in touch with you by phone during the pregnancy and the 6-week postpartum recovery. We also work with an in-home nursing service that can:
- Help care for you if you have complications such as diabetes, pre-term labor, and hyperemesis.
- Monitor high blood pressure related to your pregnancy.
The Community Health Plan Care Management team uses clinical and evidence-based guidelines as tools in its process. Community Health Plan tests how well the care management process by using utilization management reviews and concurrent reviews. These reviews find and assess potential care coordination, disease management, and discharge needs. They also help to find patients who could be helped by case management.
Providers can access care management for patients in several ways:
- Prior authorization requests
- Customer service department alerts
- Case management referral
- Referral by the patient herself or himself
The Care Management team at Community Health Plan is part of the Medical Management Department.