Care Management

man in a field during the sunset

Prevea360 cares for your patients

Sometimes navigating your way through the health care system can be challenging. That's where the Prevea360 Care Management Team comes in.

If your patients have been diagnosed with a chronic health condition or have a complex health care need, a variety of services are available to ensure their needs are met and all their questions and concerns are addressed.

For the health of your patients

We offer Disease Management programs designed to help members get answers to questions about their disease and offer support to help manage chronic health needs. The Living Healthyprogram is provided in partnership with Healthways, Inc. and specializes in supporting patient self-management through telephonic counseling, care reminders, patient advocacy and support.

Support when your patients need it most

A member may be identified for Case Management based upon a diagnosis, acute injury or from a referral by you, their health care provider. They can also request Case Management services.

Case Management is free of charge and provides them with a registered nurse who serves as a resource during a time where health care may be intense or confusing. The case manager will work with Prevea providers to meet the patient’s needs using available resources with the goal of delivering quality cost-effective care.

Focusing on quality care

The Utilization Management (UM) team uses pre-admission certification, prior authorization, concurrent reviews and discharge planning to review the appropriateness of medical services that our members (your patients) receive before and after services are rendered.

These tools allow Prevea360 to ensure members are receiving services and supplies that are medically appropriate for the member and necessary for the condition being treated. The services review includes inpatient hospital admissions, skilled nursing facility and rehabilitation care, home health care services, hospice care and behavioral health outpatient care and targeted outpatient services.

In addition, UM identifies and evaluates a patient's health care needs following discharge from a hospital and directs members to specific outpatient providers when needed.

Contact Us

Care Management Services

If you are interested in referring a patient for Care Management services, call 877-230-7555.