Recovery is Our Top Priority
MHS recognizes that members with complex medical needs often require a wide variety of resources and specialized information to help manage their health and improve their quality of life. Our case management program can help you and your members to get the special attention they need and case management services are part of their insurance coverage so there’s no extra charge for the service.
Case Manager’s Role
MHS Case Managers are specially trained professionals – a registered nurse or social worker – who works with you to help coordinate patient care. He or she provides the patient with information about their care options so that they can make informed decisions about their own healthcare needs. The case manager encourages patient involvement and assists them as they make important choices and carry out the their plan of care.

The Case Manager will work with the patient to develop a customized plan for the complex array of services their special case requires. Our efforts are focused on making sure that the care is administered in an efficient and effective manner. The Case Manager can assist in identifying the services available and provide options to maximize covered benefits.

Plan of Care
The Case Manager will consult with the patient and medical team to develop a plan of care tailored to their needs. The plan of care will include an evaluation of the anticipated medical procedures, expected recovery time and the medical, family and community resources available. Communication between the case manager and others involved in the treatment is very important to the member’s recovery.

Who Qualifies for Case Management?
Your patients may benefit from Case Management if:

• They have been diagnosed with a serious medical condition
• They have multiple injuries or medical problems
• They may be at risk for a future adverse health event due to an existing medical condition
• They are undergoing an extended hospital stay
• They are seeing several doctors
• They have had recurring re-admissions for a single diagnosis
• They may need an organ transplant
• Their condition renders them incapable of performing daily independent living activities

Communication is Key
The Case Manager knows what questions to ask, where to find answers to questions and how the pieces fit together. Generally, the Case Manager may contact the patient and treatment team by telephone and in writing, but can also arrange to visit the patient at home or at the hospital. Case Managers are available by phone during business hours, and have a voicemail box available after hours.

Complex Case Management
Complex Case Management is available for members meeting the following criteria:

• Transplants
• Multiple chronic illnesses with high utilization
• Catastrophic conditions/special needs requiring coordination of care
• Special needs populations as defined by the state, who are not already covered in an MHS Disease Management program.

Complex Case Management provides coordinated healthcare services for members who require extensive use of resources and need assistance with coordinating their care. Complex Case Managers work closely with you to ensure members receive appropriate and timely medical services. We will provide you with updates and any test results as well as information, as appropriate, regarding member compliance with testing, medications and self-management. In addition, our staff may contact you to share clinical information or to verify services received.

The Complex Case Management program offers members…

• Support from our Case Managers and assisting staff;
• Educational materials;
• Support of home health to provide care and/or additional education in the members’ homes, as needed;
• And information on MHS community events and local support groups.

MHS members are automatically enrolled in our program after they are identified with a qualifying condition. Eligibility is based on diagnosis and medical services. Membership is voluntary and members have the option to end participation at any time.

Contact Us
Our Member’s recovery is our top priority. To refer a member, or to learn if your patient qualifies, please fax a referral to 1-866-694-3653 or call MHS Case Management.

To request copies of the materials that are provided to members, please call MHS Case Management.