Special Needs Plan: Case Management - Members

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

Getting Enrolled in Case Management

You can enroll several ways in Case Management:

1. Information on Health Assessments:

The information you gave us on the health assessment(s) is used to determine if you need the services of a Nurse Case Manager or Social Worker. You will be called by a Nurse or Social Worker to talk about your healthcare and/or social needs.

2. Member Referral (Member, Family or Caregiver)

If you feel that you may need the help of a Case Manager or Social Worker, you may call us at any time and ask to be evaluated. Case Managers and Social Workers can be reached by calling 1-888-211-9913 and leaving a message.

3. Provider Referral

If your doctor feels that you may need help from a Case Manager or Social Worker, he or she can complete a referral form and send it to us. You will then be called to see if you would like to participate in this service.

Case Management is strictly voluntary. You will be asked at the beginning of the conversation if you wish to participate in Case Management and at that time you may say “yes" or “no”. If you first say “yes” and at a later date decide you do not want to remain in case management, you can elect to stop receiving services at any time.

Care Plans

All members enrolled in the SNP have a Care Plan developed that is given to your physician as a reference tool in managing your health care. See an example of a Care Plan for Tier 1 and Tier 2.

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. These Care Plans are based on Evidence-Based Medicine and Clinical Practice Guidelines.

If you are enrolled in Case Management services, your care plan will be more detailed and will be developed by you and your case manager. This care plan will be discussed with you and provided to your physician.

Last updated 10/01/2023