Page 19 - Commercial Group Member Guidebook

Care Management Programs Care Management Programs

WE OFFER PROGRAMS TO SUPPORT MEMBERS WITH SPECIAL HEALTH CARE NEEDS.

Transplant Case Management Program
The Transplant Case Management Program is designed to provide members and their families with education,
support and advocacy. A registered nurse with experience in transplant management will work with you to help
you obtain and coordinate necessary health care services and maximize your health care benefits. For more
information on this program, call 1-866-897-1038 and say “Transplant.”

Specialty Pharmacy Management Programs
ConnectiCare contracts with pharmacies that specialize in prescription drug therapies for conditions that
require unique handling. These pharmacies offer 24/7 nurse and pharmacist consultation for side effect,
administration and storage questions.

Kidney Resource Services

The KRS Program focuses on members who have been diagnosed with Stage 4 or 5 Chronic Kidney Disease
(CKD) or End Stage Renal Disease (ESRD) and are receiving dialysis at home or at a facility. For members
diagnosed with CKD, the program is designed to delay progression to dialysis and avoid co-morbidities.
If dialysis is unavoidable, the case managers provide guidance to help members choose a modality and
providers that best meet their individual needs. For members with ESRD on dialysis, the program focuses on
reducing medical complications associated with ESRD and provides each member with an individualized care
plan and education based on national clinical treatment guidelines. The program also works with all providers
involved to coordinate care including dialysis facilities and physicians. For more information on this program,
call 1-866-897-1038 and say “Kidney.”

Neonatal Intensive Care Unit (NICU) Case Management Program
The NICU Case Management Program connects families with newborns who are admitted to the NICU with
case managers who have NICU experience. The NICU Case Managers perform on-site and telephonic case
management. The goal of the program is to provide support to you during your newborn’s hospitalization and
immediately after discharge, to provide information to help you make decisions while working with the NICU to
make sure you and your baby receive the care you need.

Care Transitions Program (Hospitalization and Recovery)

If you were just discharged from the hospital you may have lots of questions. A Care Transitions Nurse Care
Manager may be calling you when you get home to see how you are doing with the transition from the
hospital, answer any questions you may have and ensure you have what you need to continue your recovery.
The Care Transitions Nurse Care Manager may also work with your doctor or doctor’s office to schedule any
necessary follow-up care.

* OptumHealth administers cancer-support services on behalf of ConnectiCare, Inc. & Affiliates. Each person with cancer has different needs.
Members are encouraged to receive care in consultation with their physician, based on their personal values, needs and preferences.

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