Case management

Our Case Management program helps coordinate health care for members who

• Are at risk for a high-cost, episodic, acute event
• Have a condition that could lead to an increased use of services
• Suffer a catastrophic health episode
  

How members are enrolled
Members are referred to or enrolled in case management services in three ways:

• All members who meet the above criteria are screened for case management services and automatically enrolled in our program.
• Our utilization management nurses review in-patient admissions and identify members likely to need case management services based on clinical and cost criteria.
• You may recommend a patient you feel needs case management services by calling the Case Management Triage Line at 616 481-9701.

How Case Management works for you
To help you manage your patients' care, we:

• Identify patients for you that require clinical support
• Provide tools and resources about specific conditions
• Communicate with you on the care and education we offered the patient
• Notify you of any needed tests, abnormal lab values or significant changes
• Work directly with your practice to maintain a high quality of care