Special Needs Plan: Case Management - Provider

The Special Needs Plan provides Case Management assistance to all members, but primarily assists those that are determined to need the most help (Tier 3). Case Managers are nurses who work with you to improve your patient’s ability to manage their health. This program also includes Social Workers who can help with community resources assistance.

Getting Enrolled in Case Management

There are several ways a member can be enrolled in Case Management:

      1. Information in Health Assessments:

The information given on the health assessments determines if your patient needs the services of a Case Manager or Social Worker. Your patient will be called by the Nurse or Social Worker to talk about their healthcare and/or social needs. Case Management is strictly voluntary. The member will be asked at the beginning of the conversation if they wish to participate in Case Management and at that time they may say “yes” or “no”. If they first say “yes” and at a later date decide they do not want to remain in Case Management, they can elect to stop receiving services at any time.

      2. Member Referral (Member, Family or Caregiver):

If the member feels that they may need the help of a Case Manager or Social Worker, they may call us at any time and ask to speak to a Case Manager or Social Worker and be evaluated. The member may call 1-888-211-9913 and ask to speak to a Case Manager or Social Worker.

      3. Provider Referral:

If you feel that your patient may need help from a Case Manager or Social Worker, you can complete a Case Management/Social Service Referral form that is provided for you in the Provider Manual and fax it to Case Management at 1-888-314-0794. Your patient will then be called to see if they would like to participate in this service.

Care Plans

All members enrolled in the SNP have a Care Plan developed that is provided to you as a reference tool in managing their health care. You can see an example of a Care Plan for Tier 1 and Tier 2 members, on the "Care Plans" section found on the - "Provider Tools and Resources" page.

Care Plans take the information your patient has provided about their health and then determines what steps should be taken to help them reach their highest level of health care. These Care Plans are based on Evidence-Based Medicine and Clinical Practice Guidelines.

If your patient is enrolled in Case Management, the Care Plan will be more detailed and will be developed by you, the patient and the Case Manager. This Care Plan will be provided to you.

Last Updated: 07/02/2018