Introduction | Prevention | Utilization Management | Disease Management | Case Management | Health Education Resources

Case Management
When care is needed most.

When faced with a serious diagnosis, your employees and their families have many questions and difficult decisions to make. CareFirst case managers, who are licensed registered nurses, help your employees navigate the complex maze of health care by coordinating necessary services and empowering them with information about their conditions.

Identification

Case management candidates are identified in several ways. The employee can contact case management directly or be referred by physicians (primary care or specialist) as well as CareFirst representatives, such as hospital discharge planners. An employee may also be identified for case management through MyHealthProfile, healthy lifestyle coaching, utilization management and disease management programs.

How Does Case Management Work?

After enrolling in this voluntary and confidential program, the employee is assigned to a case manager. After assessing the situation, the case manager coordinates the care plan with the employee and the attending physician. During the case management process, the case manager educates the employee about the plan and his or her role in it.

Throughout the program the case manager provides support to the employee and family members with disease specific information, links to community resources, and emotional counseling, when necessary.

Types of Conditions Managed

• Cardiovascular disease
• End-stage renal disease
• Transplantation
• Oncology
• Serious trauma
• Catastrophic conditions
• Rehabilitation
• Terminal illnesses
• Chronic diseases
• Pediatrics
• Extended care hospitalizations
• Multiple hospital admissions within limited time period
• Great Beginnings program for expectant mothers.  

For more information on CareEssentials, please contact your CareFirst BlueCross BlueShield representative.