Case Management

Overview Facts

Targets High-risk, High-cost and Complex Specialty Care
- Real-time identification via:
  - Utilization Management
  - Maternity Management
  - Chronic Condition Management
  - Predictive Modeling of Medical & Rx Claims
  - Biometric Screening and Health Risk Assessments

Collaborative Process to Assess, Plan, Implement, Coordinate and Monitor Care
- True patient advocacy including education, support and alternative funding assistance
- Assist Payer in determining member prognosis and projecting future treatment costs
- Comprehensive Case Management notes

Access to National Centers of Excellence and Transplant Networks
Experienced Registered Nurses and Physicians with both Specialty and Case Management Certifications
Specialized Case Management
- High Risk Maternity
- Preterm Infants
- Transplants
- Oncology
- Multiple Trauma
- Rehabilitation
- Hemophilia

Program Impact

Maximize Stop Loss Discounts
Ensure the Right Care, at the Right Time in the Right Setting
Contracted and Negotiated Savings for the Plan and Member