Molinalogo

Case Management

Molina Healthcare provides a comprehensive Case Management (CM) program to all Members who meet the criteria for services. The CM program focuses on procuring and coordinating the care, services, and resources needed by Members with complex issues through a continuum of care. Molina Healthcare adheres to Case Management Society of America Standards of Practice Guidelines in its execution of the program. The CM program is individualized to accommodate a Member’s needs with collaboration and approval from the Member’s PCP.

The Molina Healthcare case managers are licensed Registered Nurses (RNs) and are educated, trained and experienced in the case management process. The case manager will arrange individual services for members whose needs include ongoing medical care, home health care, rehabilitation services, and preventive services. The case manager is responsible for assessing the member’s appropriateness for the program and for notifying the PCP of the evaluation results, as well as making a recommendation for a treatment plan.

Members with the following conditions may qualify and should be referred for evaluation:

• High-risk pregnancy, including Members with a history of a previous preterm delivery
• Catastrophic medical conditions (e.g. neoplasm, organ/tissue transplants)
• Chronic illness (e.g. asthma, diabetes, End Stage Renal Disease (ESRD))
• Preterm births
• High-technology home care requiring more than two weeks of treatment
• Member accessing ER services inappropriately