Care management

Our HCM team may call our members if:

• They or you, their health care provider, think care management might help the member
• They have just gotten out of the hospital and need help with follow-up visits to other doctors
• They are going to the emergency room (ER) often for non-urgent care that could be handled by you, their health care provider
• They call our 24-hour Nurse HelpLine and need more follow-up for ongoing care
• They have serious physical problems and need more help managing their health
• They have behavioral health problems and need more help working with all of their doctors

Our HCM team can also help with:

• Setting up health care services for the member
• Getting referrals and prior authorizations
• Checking a member’s plan of care

From time to time, members may have questions about calls they receive from one of our HCM team. When we call, a nurse, social worker, or medical management specialist will:

• Always identify themselves with their name, title and position with Wellpoint
• Tell the member about the services we offer
• Talk to the member about their health and how they are handling different parts of their life