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Case Management Program
EXC-MBR-MDM Case Management Program page content
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
- 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
For information regarding Behavioral Health Care Management services in all regions:
Our Behavioral Health Care Managers are experienced health care professionals who are available to engage telephonically and guide members through the complexities of the health care system to support their mental health and substance use disorder needs. Behavioral Health Care Management is available for Commercial, Medicare and Safety Net Lines of Business.
Care Management Program Contact Information:
- For Access to Behavioral Health Care Management for Commercial & Medicare Lines of Business; call toll free 1-800-277-2198 Monday through Friday 8 a.m. to 5 p.m. EST. If you call after hours, leave a voicemail and your call will be returned the next business day.
- For Access to Behavioral Health Care Management for Safety Net Lines of Business (Medicaid, Health & Recovery Plan (HARP), Essential Plan, and Child Health Plus Lines of Business; call toll free 1-844-694-6411.
- Wellframe - Here Members can Chat with our Care Team, a Behavioral Health Care Manager, who can support you in determining the best plan for your treatment, and make sure you have a plan in place for medication management. Also, Members can access helpful articles related to condition, and set up reminders to keep track of appointments and medications.
- To Connect with a Care Manager from your smartphone or tablet please click below.
In addition, our plan also has a Behavioral Health Advocate who is available to assist members/member advocates or providers, that have received a denial of services. The advocate can assist with understanding clinical criteria, obtaining the clinical criteria, and/or filing an appeal or grievance for the denied service. To talk to the Behavioral Health Advocate, please call 1-844-809-7518 (Members with Medicaid, Child Health Plus, Essential Plan or HARP plans should call 1-844-635-2662).
Univera Healthcare contracts with the Federal Government and is an HMO plan with a Medicare contract. 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_5996_C.
This page last updated 10-01-2019.