How to Find Information on Case Management in Managed Care Settings

Managed-care organizations, such as health insurers and health-management companies, offer case-management services. Because the goal of managed care is to manage care costs, case management employs trained health-care workers, such as nurses and social workers, to coordinate patient care. Case managers offer education to patients and their families. They also collaborate with the patient's doctors to direct the patient's care to the most appropriate and cost-effective treatment setting. Most managed-care case-management services are conducted over the telephone, but can be on-site in a hospital or treatment center.

Instructions

• 1

  Visit your health insurance company's website and search for products and services. Under the medical section, you will likely find information about special programs such as case management, end-of-life services and disease management. Managed-care organizations often integrate these programs with each other to coordinate care and provide education.

• 2

  Call the member services number on the back of your health insurance ID card to inquire about case management programs. Ask how the program works and how it benefits the patient and her family. Inquire about who is eligible for case management services and how to participate in the program.

• 3

  Talk to the case manager if she contacts you by telephone to offer case-management services. If you have received treatment for a health condition or disease that is one of your insurer's "triggers" for case-management services, they will likely contact you directly.

• 4

  Ask your doctors about case-management services and their willingness to participate in your insurer's program. Discuss the care and treatment options with your doctor that your nurse case manager might have discussed with you.

• 5

  Read consumer information from the Case Management Society of America to get an explanation of what a case manager does and where she works. You can also email the CMSA at [email protected] with any questions you have about case management services in a managed-care setting.