Patient care management
We help you care for your patients
If your patients have been diagnosed with a chronic health condition or have a complex health care need, please reach out to the Care Management Team. The Prevea360 Health Plan Care Management Team provides individual services to ensure we meet the needs of the patient and address any remaining questions.
Disease management
We help members get answers to questions about their disease and offer support to help manage chronic health needs.
Our program supports patient self-management through:
Our program supports patient self-management through:
- Practical tips for managing the day to day challenges of your condition
- Answers to your questions about your health or any related concerns
- Support in making healthy lifestyle choices and reaching your health goals
Case management
Case management is available at no additional cost to members. It provides a case manager as a resource during a time where health care may be intense or confusing.
Your patient's case manager works with our network providers to meet your patient's needs with quality cost-effective care.
Your patient's case manager works with our network providers to meet your patient's needs with quality cost-effective care.
Utilization management
The utilization management team reviews the appropriateness of medical services that members (your patients) receive before and after services are provided. As part of the review, the team uses:
These tools allow us to ensure members receive services and supplies that are medically appropriate and necessary for their condition.
Utilization management also identifies and evaluates a patient's health care needs after hospital discharge and directs members to specific outpatient providers when needed.
- Out of Network Behavioral health outpatient care
- Concurrent reviews
- Discharge planning
- Inpatient hospital admissions
- Pre-admission certification
- Prior authorization
- Skilled nursing facility & rehabilitation care
These tools allow us to ensure members receive services and supplies that are medically appropriate and necessary for their condition.
Utilization management also identifies and evaluates a patient's health care needs after hospital discharge and directs members to specific outpatient providers when needed.
If you are interested in referring a patient for Care Management services, call: 866-905-7430.