Case Management Program

Case management is a process designed to meet individual beneficiary needs by mobilizing and integrating appropriate resources and services offered by a variety of health care providers. The process entails identifying, discussing, and adopting treatment alternatives in consultation with the attending physician, the beneficiary and his/her family, and ancillary providers. Throughout, the attending physician remains in control of the patient’s care.

Nurse case managers coordinate the provision of agreed-upon care alternatives by the appropriate providers to beneficiaries with acute or chronic conditions. Case management uses data resources, assessment and implementation tools, and oversight methods to achieve outcomes that meet the beneficiary’s needs in a cost-effective manner. The core functions of case management include assessment of beneficiary needs, development of a plan to meet those needs, coordination of services specified in the plan, and oversight of plan implementation and progress.

Case Management services are provided by Long Term Care Group nurse case managers. Generally, the caseload on any given day is approximately 1,400 beneficiaries.