Case Management Clinical Summary

How the Program Works | Benefits | Services

How the Program Works

Matria Case Management provides specialized case managers who monitor, evaluate and coordinate the treatment process for employees with the most complex medical conditions to ensure they receive the highest-quality, most cost-effective care for their individual needs.

Our experienced clinicians serve as liaisons between patients, physicians, specialists, insurance companies and employers to provide the following services:

• Secure proper medical care and equipment
• Prevent inappropriate or excessive treatment
• Expedite facility/home placement and care
• Inform insurance companies about illnesses and treatments
• Help families to understand and adjust to conditions
• Help patients find community resources
• Coordinate and provide necessary follow-up treatments
• Provide counseling, guidance and support to patients and their families

Our program offers a wide range of services, including but not limited to premature birth, high-risk pregnancies, organ transplants, traumatic head injuries, AIDS, cancer, cardiac and neurological conditions.

Benefits

Matria Healthcare offers experienced case managers, staff and consultants who have broad expertise managing critical care, insurance plan design, benefits coverage and claims procedures for major medical, disability and self-insured plans. We are knowledgeable about local, regional and national healthcare support services, including private and public organizations, in addition to specialized critical care facilities.

From Matria Case Management, you can expect:

• Personal attention from a medically trained benefits expert
• Improved patient outcomes and maximum use of existing health benefits dollars
• Narrative patient status reports
• Cost-benefit analyses that document case-by-case savings
• Comprehensive services at competitive fees

Services

Medical Case Management

• Group health – case management for insured or self-funded groups
• Disabilities – short- and long-term disability management
• Elder care – case management program for the elderly
• Care-at-home – a New York State Medicaid waiver program for infants and children
• Health data analysis
• Benefits consulting
• Health plan communication materials
• Education and training
• Patient advocacy

Examples of conditions that are case managed include:

• Cancer
• Neurological conditions
• Cardiovascular diseases
• Diabetes
• Respiratory disorders
• Premature birth
• High-risk pregnancies
• Organ transplants
• Traumatic head injuries
• HIV/AIDS