Welcome to Case Management
Case management is a free program where a case manager works with your patients over the telephone. The case manager can also work with you, the patient's family and other health care providers to determine their health needs and help them reach their health goals.
Case management can help your patient:
- Learn more about your disease or injury.
- Make better choices about health care.
- Improve safety and quality of life.
- Get quality care while lowering your costs.
Case Management Program
Role of a Case Manager
A case manager is a nurse or social worker who serves as a support for you, and helps organize care between health care providers and community resources. Case managers work to make sure your health care needs are organized and costs are kept low.
Conditions That May Benefit From Case Management
Catastrophic diagnosis
A catastrophic diagnosis is a serious health condition that can be life threatening or cause life-long disability. The cost of medical services alone for this type of health condition can cause financial hardship. Examples are head trauma or spinal cord injuries.
Chronic long-term disease
A chronic disease, such as asthma or heart failure, is one that lasts more than six to eight weeks.
Complex disease or injury
A complex disease or injury is serious and may result in limited function, longer hospital stays or home nursing care. A person with this type of condition requires regular care and review by trained health care workers and needs extensive health services.
Prolonged rehabilitation care
Recovery care can last a long time and may require extensive health services to manage or control a chronic condition.
Condition-specific case management programs may include, but are not limited to:
Children with special health care needs, maternity management (including high-risk pregnancy), neonatal care management, transplants, end of life, and Warrior Care Support.
Behavioral health
Health care for behavioral health conditions may include education and help with setting up services to address issues such as:
- multiple hospital stays
- stress of deployment on the family
- locating new providers and support services
- children and teens with serious or long term behavioral health conditions
- drug or alcohol abuse
- eating disorders that require inpatient care
- adjusting to a new mental health condition
How do I refer a patient to Case Management?
Due to the TRICARE contract transition, Health Net Federal Services is no longer accepting nominations for case management.
Additional Information
