Care Management

A team of dedicated Care Management Nurses (CMN) to Help Guide The Way

Complex heath care needs may arise bringing unanticipated costs and questions about benefits or authorizations that leave you wondering who to turn to for safe care. Because of this, we offer a care management benefit1 to members in this situation.

Our Care Management Nurses (CMN) will provide individualized attention to develop a plan of care and goals with safe, timely and cost-effective health care options—with no additional cost to you.

How it works:

  1. Eligible members are identified based on (but not limited to) the following criteria:
    1. Complex medical care requirements2
    2. Questions about care or diagnosis and how to access UHA program benefits, such as diabetes or asthma management classes, nutritional counseling, and health coaching for lifestyle changes
    3. Concerns about expenses incurred from a chronic/complex health condition1
    4. Transition planning from another health plan or to a new health plan1
    5. Hospital discharge/transition planning to home
  2. A Care Management Nurse (CMN) will contact eligible members, their family and the primary and/or specialty physician.
  3. Together, (CMN, member, member's family and provider) we will develop a plan of care and goals.

Concurrent Care

Concurrent care is receiving all medically necessary treatment which would often not be allowed if a person was in a traditional hospice program. This means that somebody with a serious illness can have all the benefits of comfort care and still receive life-prolonging treatments.

Patients who get concurrent care are supported by a team of healthcare experts. This means you get the best, well-rounded care available.

To find out more about concurrent care, Click to view Concurrent Care for Families.
 

Caregiver Resources

UHA has compiled a list of resources for those who act as caregivers in our community. The intent of this resource list is to provide caregivers a starting point for what is available in our community to help support them.

Click to view the resource list.
 

Advantages to care management

  • Cost-effective quality care. The CMN will collaborate with physicians to ensure optimal health for each member.
  • Patients return home faster. The CMN will help to expedite a timely case handling, which allows you to return home sooner.
  • Risks of complications are reduced. Hospital-induced complications such as infection, blood clots, etc. are reduced.
  • Home or hospice care benefits are managed. The CMN can coordinate your benefits, which can include purchase or rental of durable medical equipment and various types of therapy.

Who can refer me for Care Management?

You can request Care Management services for yourself, or your physician can refer you by calling 532-4006. Ask to speak to a Care Management Nurse.

References:
  1. Care management is a covered benefit with no co-payment. Refer to your Medical Benefits Guide for any co-payments that may apply.
  2. Contact Health Care Services with questions regarding referral criteria.