Concurrent or Retrospective Clinical Review- HC21 will provide a nurse credentialed in case management to identify high risk/high cost members and collaborate with the health plan or vendor to review their care. The review will focus on clinical interventions by Case Management (CM) / Disease Management (DsM). Findings will be reported to the employer member with recommendations; such as increasing consumer incentives, strengthening health plan performance standards and other recommendations for process improvement.
Clinical Transition Oversight- When transitioning from one health plan to another, HC21 provides oversight to assure continuity and to minimize disruption of clinical services, like CM and DsM.
• HC21 can identify employees with high cost claims and high health risks.
• HC21’s nurse can assess if the new plan has contacted and enrolled employees in CM and DsM.
• The nurse can also request the plan to give evidence of participation at certain intervals.
• Participation is reported to our member to address issues, such as consumer incentives and health plan performance.
Health Nurse- HC21 can assist the employer with hiring (contracting) a nurse, job orientation, mentoring and managing.
Clinical positions would perform the following duties:
• Assure complete, accurate health risk assessments
• Collaborate with health plan / vendor to match population with the correct health plan service
• Monitor clinical goal achievement
• Provide health coaching as needed
• Provide recommendations to the employer to improve the effectiveness of clinical intervention
• Evaluate and maintain databases to identify targeted populations
• Perform clinical reviews as described above
Please contact Gaye Fortner- HC21 President and Chief Executive Officer