Case Management

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Case Management 2017-07-04T00:25:05+00:00

The Complete Solution to Managing All Your At-Risk Members

MCM recognizes and understands that not all diagnoses and patient needs are the same. MCM provides case management in three categories; episodic, large/catastrophic, and specialty case management. Episodic is for members who may need short term case management due to a surgery and rehabilitation versus someone who is battling a long-term disease such as cancer (specialty case management). MCM employs registered nurses and physicians with both specialty and case management certifications. MCM’s comprehensive nursing team not only consist of nurses trained and experienced in multi-trauma, End Stage Renal Disease, high-risk pregnancy, complex medical/surgical cases, but also nurses certified in specialty areas. Cases are assigned to Registered Nurses who are certified and experienced in member’s medical care needs.

Case Management services include:

  • Case identification through methods such as: precertification process, predictive modeling, medical plan design, marketing, and outreach programs
  • Assessment, planning, facilitation, care coordination, advocacy options and services for member and family
  • Review and monitoring of appropriateness of medications and services, location of services, quality of care, and lengths of stay