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Care Management

Last updated: Nov. 12, 2020

We provide case management services to members with complex medical conditions or serious psychosocial issues. The Medical Case Management department assesses members who may be at risk for multiple hospital admissions, increased medication use or who would benefit from a multidisciplinary approach to medical or psychosocial needs.

Pharmacy management, including asthma-related care, is part of our Care Management program. Otherwise, we provide pharmacy management through OptumRx. OptumRx administers clinical, patient-focused Disease Therapy Management (DTM) programs offered as part of Specialty Pharmacy Care Management services. These programs help improve patient quality of care through education and communication.

OptumRx Specialty Pharmacy offers DTM programs for the following disease states/conditions required by the Board for the Washington Apple Health programs:

  • Rheumatoid arthritis
  • Growth disorders
  • Risk of respiratory syncytial virus due to prematurity

Additional programs provided to Apple Health program members include:

  • Hepatitis C
  • Multiple sclerosis
  • Anemia related to chemotherapy
  • Comprehensive medication management therapy

The plan of care (POC) addresses the following areas:

  • Psychosocial adjustment
  • Nutrition
  • Complications
  • Pulmonary/cardiac rehab
  • Medication
  • Prevention
  • Self-monitoring of symptoms and vital signs
  • Emergency management/comorbid condition action plan
  • Appropriate health care utilization

Our Care Management program is supported by our integrated clinical system. The system includes basic and comprehensive supplemental assessments, facilitates the development of integrated care plans and uses ongoing monitoring and evaluation tools.

Refer members for case management by calling Care Management at 877-856-6351. Additionally, UnitedHealthcare Community Plan provides the Healthy First Steps program, which manages women with high-risk pregnancies.