Case Management Helps Medical Plan Participants with Complex Health Care
A voluntary benefit of the NRECA Medical Plan, case management connects covered participants with a certified UMR nurse case manager to help them understand, plan and coordinate their health care services from their diagnosis until their treatment plan is stable to ensure better outcomes and lower costs. Conditions triggering case management include heart attacks, high-risk pregnancies, cancer treatment as well as other serious illnesses and injuries.
Once need for case management is identified, either through a Simplified Hospital Admission REview (SHARE) program1 preauthorization request, medical claim or referral, a nurse case manager quickly contacts the participant by phone to discuss his or her situation and answer questions. If the participant agrees, the case manager will work directly with them and their health care providers on the recommended treatment plan; otherwise, the nurse case manager will work behind the scenes to assure the participant receives appropriate, cost-effective medical care.
Resources for BAs and participants
You can find out more about case management by visiting the new BA Guide Case Management page. Along with the information provided there, a video and flier, which you can use to educate your cooperative’s participants about the service, are also available.
A case management section has been added to the SHARE (Preauthorization) page for participants on the Employee Benefits website to provide information and resources directly to participants.
If you or your participants have questions about case management, call the SHARE program at 800.526.7322 from 7 am to 6 pm, Central time, Monday through Friday.
1NRECA Medical Plan participants must contact SHARE at 800.526.7322 for all hospital admissions and medical care that requires preauthorization. If the participant accesses the Choice Plus network, the provider, facility, or both, are responsible for preauthorizing inpatient hospital admissions. In the case of hospitalization during an emergency, SHARE must be contacted within two business days including non-business hours but excluding weekends and federal holidays.