Providence Care Management
Our experts help you find your way to healthy
The registered nurses, social workers, clinical support coordinators and technicians who make up the Providence Care Management team will help you better understand your health so you can take an active role in improving it. Whether you need help with understanding a new diagnosis or assistance navigating options for a diagnosis that has been affecting one’s life for a long time, Providence Care Management is here to help.
Care managers help you better understand your condition and support you on your journey so you can take a more active role in meeting your health goals. With these services, you'll receive personalized support with health conditions including, but not limited to:
- Chronic obstructive pulmonary disease, or COPD
- Heart failure, or HF
- Coronary artery disease, or CAD
- Rare conditions such as Parkinson’s disease, Multiple Sclerosis, hemophilia, and kidney disease
- Complex health issues requiring hospitalization, rehabilitation or extensive outpatient therapies
- Pregnancy and post-partum
- Support to caregivers of children who need help managing a chronic condition or illness
- Mental Health
- Substance Use
Members may be referred for care management services by:
- Member self-referral
- A caregiver (e.g., spouse, family member, friend or neighbor providing care to the member)
- ProvRN nurse advice line
- Hospital discharge planner
- Disease Management
- Utilization Management
Our care managers provide you with:
- Personalized health education about your medical concern, including new innovations, medication therapy and symptom management
- Coordination with your provider and care team
- An individualized plan developed with you to help you reach your health goals
- Ongoing one-on-one telephone support
- Advice on general health and lifestyle choices to help reduce risks, including nutrition and exercise
- Encouragement and support to help through the easy, and not so easy, times
- Support with prior authorizations or provider referrals
- Assistance navigating health care services in your area
Care Management services are open to all Providence Health Plan members and available at no cost. Participation is voluntary and declining/opting-out may be done upon contact with your case manager or by contacting us by phone. For more information or to learn more about what resources are available to you based on your specific condition, read our FAQs below or contact us by phone at 800-662-1121 (TTY: 711) or email firstname.lastname@example.org.
Frequently asked questions
I'm having trouble finding the right provider to fit my health goals. Can you help?
We provide personalized support in finding a care team that’s right for you.
Can you help with my new diagnosis?
New diagnoses can be scary and stressful; we can help. We’ll walk with you through this condition including finding in-network providers and facilities, understanding your diagnosis, symptom management, medications, treatment plans, and assist with finding possible financial assistance when needed.
My doctor has suggested a procedure that requires a prior authorization from the health plan and I don't know what to do!
We’ll shepherd your request through the prior authorization process to ensure your personalized health care needs are known to your care team.
My medication is too expensive for me to afford. Can you help?
We will assist you in connecting with your provider and pharmacy to find the lowest cost options as well as secure any available assistance from pharmaceutical companies or other financial resources.
I need medical equipment but keep getting the run around from the medical equipment company and I don't know what to do.
We will make the calls for you to track down your provider’s order, authorization, and equipment to be sure you have what you need.
I (or a family member) was recently in a catastrophic accident or experienced a life changing event. Where do I start?
We can assist with coordination of care and securing resources in unexpected life events, whether new physical or cognitive limitations requiring assisted living or in home care, financial support, community support and resources.
I'm new to the health plan and in the middle of treatment for a condition. Can you help me understand my new coverage and where to go?
We’ll help you transition your care to providers, facilities and pharmacies that are in your plan. If your treatment is active, we will help you gather the clinical information necessary to finish your treatment with your current provider under the Transition of Care process.