Medical case management definition

Medical case management means the planning and coordination of health care services appropriate to achieve the goal of medical rehabilitation. Medical case management may include medical case assessment, including personal interview with the injured worker, assistance in developing, implementing and coordinating a medical care plan with health care providers in consultation with the injured worker and his or her family, and evaluation of treatment results. The goal of medical case management should be to avail the injured worker of reasonable treatment options to ensure that he or she can make an informed choice. Medical Case Managers shall not provide medical care or adjust claims.
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Medical case management means services provided by a Primary Care provider to ensure the coordination of Medically Necessary health care services, assuring the provision of preventive services in accordance with established standards and periodicity schedules and ensuring continuity of care for Medi-Cal enrollees. It includes health risk assessment, treatment planning, coordination, referral, follow-up, and monitoring of appropriate services and resources required to meet an individual’s health care needs.
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Medical case management means a collaborative process that facilitates recommended treatment plans to assure the appropriate medical care is provided to disabled, ill, or injured individuals.
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Examples of Medical case management in a sentence

  • Medical case management shall be provided by COUNTY public health services.

  • Medical case management and early intervention services are planned for bidding in Fiscal Year 2024-25.

  • Service Definitions: Medical case management services are a range of client-centered services, including treatment adherence, that link clients with health care, psychosocial, and other services.

  • Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments.


More Definitions of Medical case management

Medical case management means Medical Disability Management and Utilization Management. "Medical Disability Management" means the determination of medical necessity, appropriateness of care, length of stay, intensity of service related to treatment of HCO Enrollees by Network Providers. "Utilization Management" means the management, assessment, improvement or review of patient care and decision making through case by case assessment of the medical reasonableness or medical necessity of the frequency, duration, level and appropriateness of medical care and services, based upon professionally recognized standards of care, which may include prospective, concurrent or retrospective review of a request for authorization of medical treatment.
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Related to Medical case management

  • Case management means a care management plan developed for a Member whose diagnosis requires timely coordination. All benefits, including travel and lodging, are limited to Covered Services that are Medically Necessary and set forth in the EOC. KFHPWA may review a Member's medical records for the purpose of verifying delivery and coverage of services and items. Based on a prospective, concurrent or retrospective review, KFHPWA may deny coverage if, in its determination, such services are not Medically Necessary. Such determination shall be based on established clinical criteria and may require Preauthorization.

  • Targeted case management means services that assist a beneficiary to access needed 2 medical, educational, social, prevocational, vocational, rehabilitative, or other community services. The 3 service activities may include, but are not limited to, communication, coordination and referral;

  • Medical care means amounts paid for:

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Case management services means planned referral, linkage, monitoring and support, and advocacy provided in partnership with a consumer to assist that consumer with self sufficiency and community tenure and take place in the individual’s home, in the community, or in the facility, in accordance with a service plan developed with and approved by the consumer and qualified staff.