Care Management Department

The Care Management Team at Community Health Plan is part of the Medical Management Department.

Care Management is a comprehensive method of client assessment—designed to identify client vulnerability, needs, and goals—that results in the development of an action plan to produce an outcome that is desirous for the client. The goal is to provide client advocacy, a system for coordinating client services, a systematic approach to evaluation of the effectiveness of the client's health maintenance, and most importantly, supporting the client-provider relationship.

Community Health Plan's Care Management Team utilizes clinical guidelines and evidence-based guidelines as tools to facilitate the care management process. The care management process is monitored through utilization management review activities, concurrent review activities, which assess and identify potential care coordination, disease management, discharge needs and case management candidates. Providers can access care management for patients in several ways, through prior authorization requests, customer service department or through a case management referral.

Community Health Plan can help to support high-risk moms during pregnancy or postpartum recovery. If you need this support, case management will keep in touch with you by phone during the pregnancy and the 6-week postpartum recovery. We also work with an in-home nursing service that can:

Help care for you if you have complications such as diabetes, pre-term labor, and hyperemesis.
Monitor high blood pressure related to your pregnancy.

The Care Management Team consists of clinical and nonclinical staff in the following areas:

Please click the link for each area to learn more about it.

If you would like to see additional topics discussed, please contact us.