What is Care Management?

Our professional Care Managers advocate on behalf of patients/clients through a  professional and collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs.

• Support for client and family to improve patient care and reduce the need for medical services by helping clients effectively manage health conditions
• Weekly/monthly medication management
• Assist and follow-up with doctor appointments
• Weekly/monthly nurse visits
• Individual care plan created by nurse in collaboration with client and family
• Care Managers typically spend 10 hours initially to complete the assessment, maintain medical records, reconcile medication list and follow up with doctors
• Transitional Care Management – Services to help with transition to the community setting following discharge from hospital/SNF, work with MD and ancillary services to prevent readmission to the hospital
• Chronic Care Management For clients with chronic conditions, to help coordinate care, medical appointments, follow-up to enable client to stay in their home or preferred living option.
• Review and Assist with Long Term Insurance Company – Assist with  paperwork, help set up claim, referrals to elder law attorneys or guardians