3. Patient Care Management

Patient care management

Female physician working with patient

We care for your patients

If you have patients with chronic health conditions or complex health care needs, we're here to help. Contact our Care Management Team so we can provide them with individualized support. We can answer their questions and ensure they get the right care.

Disease management

We offer a range of services to support your patients as they manage their chronic health issues. We can help them address barriers to self-management through:

  • Telephone counseling
  • Care reminders
  • Referrals
  • Support from social workers to address social determinates of health
  • Long-term patient advocacy and support.

Case management

Your patients can get extra support when their health care needs are intense or confusing. A registered nurse will provide case management services. They'll work with in-network providers to ensure your patients receive cost-effective care. There is no extra cost for this service. Call 1-866-905-7430 to make a referral.

Utilization management

Our Utilization Management (UM) team helps ensure our members get appropriate care. They'll review medical services before and after those services are provided. As part of the review, they may consider many types of clinical information, including: 

Medical records such as:

  • Diagnosis codes
  • Office and hospital records
  • Physical exam results
  • Diagnostic testing results
  • Treatment plans and progress notes

Historical records regarding:

  • The presenting problem
  • The patient’s psychosocial state
  • Consultations with the treating provider
  • Evaluations from other providers
  • Rehabilitation evaluations

Request-specific information regarding:

  • Request criteria
  • Benefits for services or procedures
  • Local delivery system
  • Patient’s characteristics