Case Management

As part of our ongoing commitment to improving and maintaining good health and well being, we offer our Case Management Program. This program will help you manage your health with the collective efforts of your physicians, case manager and our many other resources.

What is Case Management? Case Management is a process designed to assist individuals who:

• are high-risk for chronic disease
• have an illness that could lead to a high-risk condition
• have a need for increased use of health care services

24 Hour Toll Free at (877) 442-1181

This program helps ensure members living with illness get medically necessary and appropriate health care. Our case managers work together with the member, primary care physician and other health care resources to:

• assess the member's health care needs
• coordinate the member's health care services
• develop a customized plan that includes health promotion and disease prevention
• help the member monitor their customized plan
• evaluate treatment plans on an ongoing basis and make appropriate adjustments to improve the health and well being of the member

Care Choices Case Managers are highly trained and experienced registered nurses. Our nurses use the most up-to-date health care guidelines to help members achieve the best possible outcomes.

All Case Management services and coordination are provided by telephone, giving members easy access to these health care resources.

Coordination of health care services across many settings include:

• outpatient
• pharmacy
• emergency
• home health care
• inpatient
• durable medical
• behavioral health equipment
• nursing home
• community resource

Members who are interested in enrolling in the Case Management program should talk to their primary care physician. Members are also automatically assigned to the Care Choices Case Management Program if they have:

• been referred by a Care Choices Disease Management Program Nurse coordinator
• been scheduled or will be scheduled for transplants
• a history of frequent and multiple prescriptions
• a history of frequent ER visits and/or inpatient admissions
• a history of chronic disease and/or other catastrophic conditions that may require coordination of care, such as:
  • Acute myocardial infarction (heart attack)
  • Cerebro-vascular accident/CVA (stroke)
  • Congestive heart failure (CHF)
  • End Stage Renal Disease (ESRD)
  • Premature infancy
  • Spinal cord injury
• complicated and/or high-risk conditions as identified by the Care Choices Case Management staff and Medical Director

Case management services begin only after the member has provided their approval to Care Choices.

Care Choices Case Managers can help members cope with all kinds of health care challenges. Here is just what one satisfied member had to say about our program:

"...I have been a Care Choices member since 1994 ...I have always been pleased with our care. On June 17, 2001 (Fathers's Day) we had (a) three pound son ...who had several issues with his health. Shortly after his birth (our case manager) phoned me to tell me she was assigned to (his) case and to call her when I needed assistance..."

"...It was hard to deal with the myriad of problems with my son—but having someone like (our case manager) to help us—made it that much easier..."

"...Again, (she) has been fantastic and her personal attention has been greatly appreciated by our whole family."