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Case Management

If you’re managing a serious health condition, our registered nurses can help you better understand your diagnosis, so you can follow your doctor’s treatment plan.

If you have a serious or complex health condition, we can help you get the care and services you need. Our specially trained Care Managers from our Case Management Program will help coordinate your health care services with your doctor. The Case Management Program provides eligible1 members the education and guidance they may need when faced with a complex medical situation such as:

  • A high-risk pregnancy or a newborn with medical issues
  • A cancer diagnosis
  • The need for heart surgery, an organ transplant, ventilator management, extensive home care or home infusion
  • A severe injury or paralysis
  • Chronic Kidney Disease (CKD)
  • End-Stage Renal Disease (ESRD)
  • Supportive care
  • Other general and pediatric conditions

Our trained Care Managers are fully licensed health care professionals and registered nurses. They will work with you and your treating doctor so that you have access to the best care possible.

Through the program, our Care Managers can:

  • Regularly discuss your overall medical situation with you and your doctor(s) to help you make decisions about your health care
  • Provide educational material, advocacy and professional guidance about managing your health and information about your medical condition
  • Help you locate and coordinate appropriate care for your needs
  • Help you get prior authorizations for services
  • Refer you to other programs or services when needed
  • Assist you in understanding how to maximize your plan benefits to minimize your out-of-pocket costs related to your condition

This is a free and voluntary program available to all eligible members. Prior Authorization may be required.

Eligible members may enroll themselves or an eligible dependent in the Case Management Program by calling 1-888-621-5894 and selecting option 2. Representatives are available for assistance Monday through Friday, from 8 a.m. to 5 p.m., Eastern Time. All medical and personal information is confidential and shared only with those involved in your care.

Members can also be referred to our Case Management Program from other departments, including our Utilization Management department and Care Management Plus Program department, the 24/7 Nurse Line, as well as, rehabilitation facilities, facility discharge planners, behavioral health providers, practitioners, caregivers and pharmacy vendors.