Common use of CASE MANAGEMENT PROGRAM Clause in Contracts

CASE MANAGEMENT PROGRAM. The Case Management Program is a service for Members with complex medical needs or who may be at risk for future adverse health events due to an existing medical condition or who may require a wide variety of resources, information, and specialized assistance to help them manage their health and improve their quality of life. The program assigns an experienced case management nurse or coordinator to a Member or family caretaker to help make arrangements for needed care or to provide assistance in locating available community resources. Case management services provided to Members are numerous and are always tailored to the individual needs of a member. Participation in the Case Management Program is voluntary and involves no additional cost to our Members. Services often include, but are not limited to:  Assistance with coordination of care;  Discussion of disease processes;  Facilitating arrangements for complex surgical procedures, including organ and tissue transplants;  Facilitating arrangements for home services and supplies, such as durable medical equipment and home nursing care; or  Identification and referral to available community resources, programs; or organizations. This program is comprised of a dedicated oncology case management team of specially trained staff experienced in cancer care and end-of-life issues who provide assessment and support to members at all stages of adjustment to a cancer diagnosis. Core goals of this program include education regarding early symptom identification and pain management, increased member understanding of and satisfaction with their treatment plan, improved overall quality of life, and improved coping surrounding end-of-life issues. Care coordination benefits of the program include: management of care and services between the members, their family, providers, vendors, and the health plan; appropriate utilization of services; and the potential for cost savings through reductions in potentially avoidable admissions and emergency department use This program is comprised of a dedicated transplant case management team specially trained and experienced in transplant care that provides assessment, education, and support during the transplant process. Core goals of this program include education and support regarding treatments, medical benefit plan, and Blue Distinction® Centers for Transplants. Care Coordination benefits of the program include: coordinating the exchange of information between the hospital, physicians, and the health plan that is required for evaluation and authorization of required services, consultation with medical/surgical transplant team, and ordering/requesting specialists to implement a member-centric plan of care, facilitating expected rehabilitation and convalescence needs, and identifying available medical, family, and community resources.