Care management services offered by Priority Health
Our care managers help coordinate health care for Priority Health 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 of Priority Health plans can be enrolled in care management services in three ways.
Automatically: All members who meet the above criteria are screened for care management services and automatically enrolled in our program.
Inpatient admission reviews: Our utilization management nurses review inpatient admissions and identify members likely to need care management services based on clinical review for clinical appropriateness and transitional needs.
Provider referrals: You may refer a patient you feel needs care management services to the care manager assigned to the patient. Either send your referral using your secure Mailbox. If you're not logged in, call the Provider Helpline at 800.942.4765, option 1.
How Priority Health care 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
Care management referrals
Send us the patient's name, contract number, DOB and clinical information using your secure Mailbox. Simply choose "Care management referrals" from the list of "To" addresses.