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Home > Health Plans > Employer Partnership Program 


Case Management Strategies

Why is case management important?

One of the biggest challenge in managing healthcare is finding access to specific types of health care where and when people need it. Case Managers are a valuable resource to help ensure that employee gets the health services and benefits they need to make the best recovery possible.In cases where a worker has injuries or personal circumstances that complicate the recovery process, the case manager will act as their advocate and advisor, assisting their progress through a sometimes complex health care and benefits system. Case management’s role is to coordinate and facilitate access to timely and appropriate health care services, and ensure continuity throughout the recovery process.

What We Offer

Our team of case managers is dedicated to improving the quality of health of our members; especially those with unique and complex care needs. Case managers are skilled in helping members learn how to identify needs and access appropriate services. St. John’s offers a multi-disciplinary approach to providing resources to improve members’ health. Case managers work with physicians and other providers to assist members with their health care needs in a variety of ways, including:
Disease specific education materials
Call center support Community support services

How We’re Different

All of our programs are developed, reviewed and updated with St. John’s Health System involvement and oversight at every level. A local Medical Director is available to provide timely decisions.

Case management benefits

  • Coordination of medical care through Utilization Management and Prior Authorization Management
  • Collaboration with the PCP and improved communication with the multidisciplinary team
  • Health education and health plan benefit education
  • Information regarding community resources
  • Information regarding support groups
  • Assistance with applications for financial aid
  • Referrals for disease management programs
  • Referrals for social services assistance
  • Assistance with access to in-network providers
  • Management of all out-of-network medical care
  • Coaching and encouragement for members promoting compliance with the medical treatment plan
  • Supportive care
  • Member and family empowerment
  • Promotion of quality care that is also cost effective

     

  • A member of the
    Sisters of Mercy Health System