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Case and Disease Management

What is Case Management?

Case Management is a program designed to help members needing additional assistance to reduce health risks and achieve health goals. In case management you are assigned a case manager that works with you to assess your health needs and to develop a plan of care. A case manager may be a nurse or other professional who will also provide support during the process.

The plan is committed to early identification of members who may be at risk for health care needs or services. We identify eligible members for case management through multiple sources which include Health Risk Assessments, referrals from providers, utilization management team or through pharmacy data. You may also self-refer into our case management program.

Once a referral is made a case manager will try to contact you to identify your individual needs and begin the process.

 Simply Healthcare Plans Case and Disease Management programs are of no cost to you and part of the services you receive as a member.  We have a variety of special programs that can help meet your needs. The following are a list of programs available:

  • Asthma
  • Behavioral Health
  • Complex Needs (Multiple Conditions)
  • Congestive Heart Failure
  • Diabetes
  • High Blood Pressure
  • HIV/AIDS
  • Maternity (Pregnancy)
  • Oncology (Cancer)
  • Smoking Cessation
  • Special Needs (Simply Care, Simply Comfort, Simply Complete, and Simply Level)
  • Weight Management
 
If you are interested or want to learn more, please call our Case and Disease Management Department toll free at: 1 (855) 431-1606 (TTY 711).  
 
Mondays through Fridays from 8 AM to 5 PM EST. 
 
You do not need to call if you do not wish to participate. You can also change your mind at any time.  
 

Beacon

Beacon is our partner in ensuring your behavioral health needs are met. For more information on Beacon, click here: http://www.beaconhealthoptions.com/members/


Health and Wellness

For information about diabetes, click http://www.diabetes.org
 
 
Last Updated: 
November 6, 2017