Providers like you can refer ConnectiCare patients to our case management team for help to manage their conditions. Simply call us at 1-800-829-0696.
Our case managers work to help members get healthier and improve their daily-living skills. We do this by working with providers and our members to:
- Improve access to care, so members with complex health conditions get the right services for their conditions
- Support members in scheduling follow-up hospital and doctor appointments
- Coordinate medical care and community services for members who get a lot of services or see many doctors for their conditions.
We will call members to find out their conditions. Then we find benefits and resources available to them and come up with comprehensive care management plans.
Our care management team includes:
- Registered nurses, who make initial calls to the members and develop plans based on their goals and needs.
- Field care managers, nurses who visit members in their homes or convenient locations to talk about their medications and their conditions. This nurse visit doesn’t cost members anything. It’s an included benefit under their plans.
- Social workers, who work to get available state, local or community resources that can help members. This can include behavioral health referrals.
- Navigators, who support the case managers with specific tasks.
Here’s an example of how our case managers have helped
A member went to the emergency room four times in a span of four weeks. She had a sore throat and it felt like something was stuck in her throat. It turned out the condition was minor. She could have gone to a walk-in center or her primary care provider (PCP) for treatment.
The member didn’t know the difference between a walk-in center and emergency room. After she was referred to us, we explained to her the differences of services and costs. We told her that under her plan:
- An emergency room would cost $200
- A walk-in center visit would cost $75
- A PCP visit would cost $40
We gave her information about Spanish-speaking doctors and bilingual walk-in centers near her.
Our case manager also worked with her doctor and pharmacy to make sure the member was taking the right cholesterol-lowering drug. The member was taking two cholesterol-lowering medications a day, which was unusual. Our case manager called the doctor and found the member should only be taking one medication a day.