Our case managers are available to assist our members by coordinating services for easy access to medical care through a variety of services, such as:
• Health and Wellness Referral
• Complex Case Management
• Behavioral Health
• Transition of Care
Case managers are also in charge of administering the Centers for Medicare & Medicaid Services (CMS) required programs such as:
• Chronic Condition Improvement Program
• Quality Improvement Project
MediGold’s knowledgeable and caring case managers provide education and medical and emotional support for members. They refer members to health and wellness resources in their community. For members who are "high risk," they collaborate with a treatment team to create member-specific, cost-effective health care options to share with the member and their family. Targeted members may have chronic conditions such as chronic obstructive pulmonary disease, congestive heart failure, diabetes or an acute illness requiring coordination of multiple services, short-term intensive intervention or long-term education and monitoring. The goal of case management is to facilitate maximum functional levels at the most appropriate intensity of service.
Case management is conducted by telephone and includes a needs assessment, development of a care management plan, on-going monitoring and case closure. All case management program processes are documented in standardized formats and closely coordinated with aspects of utilization management, including prior authorization and concurrent review.
If you identify a MediGold member who is at risk for high utilization of services or who needs assistance in coordinating health care services, please submit a Case Management Referral Form. You can find this form at: MediGold.com/For-Providers/Tools-and-Resources/Forms
Complex Case Management Program
Transitions of Care Program
Disease Management (DM) Program
Chronic Condition Improvement Program - Chronic Obstructive Pulmonary Disease (COPD)
Case Management Referral