URAC

Wellness

Case Management

Case management is a collaborative process which coordinates, monitors and evaluates options and services to meet an individual's health needs to promote quality cost-effective outcomes. The key to successful case management is early identification of individuals needing assistance.

HDP applies a consistent set of criteria to screen potential candidates for case management. The criteria consist of specific diagnoses as well as situational circumstances to target potential candidates.

Case management opportunities are identified in a variety of ways, including:

  • Utilization management
  • Claim data and provider
  • Family or patient referral

The program is voluntary and goal setting is a collaborative process between the case manager, patient and/or family member and provider. A case manager's assignment is client-specific, so that he or she has an excellent understanding and knowledge of the client's plan benefits.