Emergency Room Diversion Management 

The emergency room diversion management program is an outreach program to help educate members on navigating appropriate levels of care in the health care system. The focus is on members who use the emergency room for non-emergency encounters that may have otherwise been managed at a primary care or urgent care level. The program employs a clinically experienced, licensed social worker and medical assistants to help promote strategies and resources to redirect members to alternate levels of care providers to avoid overutilization of the emergency room for non-emergency conditions.

Care Calls

The Care Calls program is an outreach program to help members transition from hospital to home. The focus is on members who have immediate discharge concerns or may be at risk for complications or readmissions. The program helps to prevent or address any gaps in care by contacting these members within 48 hours of discharge and providing education and any necessary care coordination, authorization or referral. This value-added service is provided at no charge.

NICU Case Management

We offer the NICU Case Management program to infants who have certain conditions. These conditions include but aren’t limited to complications associated with premature birth, congenital birth defects, hydrocephalus, seizures, cystic fibrosis and genetic disorders. Clinically experienced certified nurse case managers work closely with the caregiver and the member’s providers to ensure ongoing communication and coordination of care.