Case Management Program

Our Care Management program provides a mix of benefit management and individual care planning to members diagnosed with a complex medical illness. Our skilled case manager will work with you and your health care team to develop short and long-term goals to help you maintain your quality of life-or, in some cases, make it better. Follow this link to learn about our Program for Children with Serious Illnesses.

To be eligible, you must:

  • Have an active health care policy administered by us
  • Agree to participate in our Care Management program
  • Have a need that requires guidance, counsel and access to information for chronic and complex conditions including determining available member benefits and resources

Services include:

  • Personalized care and coordination of services provided by a nurse case manager
  • Development of a care plan that addresses both your and your physician's health care goals
  • Assistance with benefit information to you and your health care team
  • Help obtaining referrals to community resources
  • Ability to be a liaison between you and your health care team

Care Management can:

  • Emphasize the importance of maintaining regular contact with your physician's office
  • Inform you about valuable community resources that can help with management of your illness
  • Offer tips on how to follow the treatment plan developed by your physician

Care Management Consent for Certain Conditions

We require your consent to participate in care management for certain conditions.  These conditions include:

  • Mental health
  • Substance use disorder
  • HIV/AIDS

Please review and sign the consent form to take part in care management for these conditions.

Your completion of this form is your agreement to care management services and supports, which includes collaboration with your treating providers. For minors with substance use disorder or HIV/AIDS conditions, the consent form must be signed by the member themselves. This is because state and federal regulations require the individual to consent to their own care for these conditions regardless of age.

Learn More:

For more information about the program:

For information regarding Behavioral Health Care Management services in all regions

Univera Healthcare is an HMO/PPO/HMO D-SNP plan with a Medicare contract and a contract with the New York State Medicaid program. Enrollment in Univera Healthcare depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_10520_C.

This page last updated 10-01-2024.

 

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