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 / Disease Management. 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 minimize disruption of clinical services like Disease Management/Case Management.
- HC21 can identify employees with high cost claims and those with high health risk.
- HC21’s nurse can then take the information to the new health plan and assess if these employees have been contacted and enrolled in Disease Management/Case Management.
- The nurse can also request the plan to give evidence of participation at certain intervals.
- Participation is reported back 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, then with job orientation, mentoring, and managing.
This clinical position would perform the following:
- Assure complete, accurate health risk assessments
- Collaborate with the health plan / vendor to match their 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
- Performs clinical reviews as described above
If you are interested in this program please contact:
Gaye Fortner, Senior Vice President, COO
865.292.2123
gfortner@hc21.org
