Case Management

 

Prairie States Case Management is a clinical service that advocates on behalf of members facing severe and complex medical conditions. The goal: the best possible outcomes at the best value for the plan.
 
Designed to ensure quality, safety, appropriateness of setting and cost control, Case Management helps members when they need it most. Registered Nurses, who hold certifications expressly for this program, engage members facing a variety of medical issues, including:

 
  • Cancer care
  • Dialysis
  • Multiple chronic conditions
  • Traumas
  • High-risk pregnancies
  • Transplants and more


 
Program Participation
Members who are identified as candidates for Case Management are contacted and encouraged to participate in this voluntary program. When they elect to take part, Prairie States helps them manage their procedures, conditions and treatment plans with their providers.
 
Transitions of Care
To reduce complications – and avoid costly readmissions – the Case Management program stays engaged with the member throughout recovery. Following major surgeries, inpatient stays, maternity and condition management needs, Registered Nurses manage Transitions of Care. They offer clear, detailed discharge education, and monitor follow-through with physician appointments, dressing changes, and medication adherence.
 
Complete Integration
Collaboration and integration are key. The Case Management team works closely – and in real time – with you, members, claims examiners, and providers. Diverse members of the Health Management team combine their expertise, working together to ensure that necessary and cost-effective treatments are used to best serve all members.
 
Quality Care, Personalized Attention, Unmatched Savings
The exceptional patient care and plan savings realized through Prairie States’ Case Management program are no fluke. With nurses comprising over 30 percent of our staff, the depth of our clinical expertise and experience are unique in the industry. From diagnosis to recovery, the entire Case Management team works tirelessly during every step of the treatment process to ensure that all members engaged in the program get the quality care and attention they deserve—all at the best value for the plan.