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Types of Care Managers

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Types of Care Managers

By Sheryl Riley, RN, OCN, CMCN

Believe it or not, as a health plan member you have the right to request and work with a care manager. Most health plans have both, even hospitals and large practices. However, while they are a great resource, not all care managers are nurses, and that can make a difference for you health. Today, various titles for members of a care team are used interchangeably to describe different types of professionals like:

    -RNs -LPNs -Licensed Social Workers -Social Workers -Community Health Workers -Laypersons

Ten to fifteen years ago, care managers were only registered nurses. In today’s industry, any one of the above medical professionals can hold the title of care manager, case manager, care coordinator, navigator, or care coach.

When seeking a care or case manager, remember to request their credentials. You should know the type of medical professional you will be working with. Professionals without licensure can assist you with benefit questions, doctors in network and cost of medications, but they cannot provide clinical advice or education. If the care you are seeking is primarily social, environmental or behavioral, social workers acting as care managers may be a good fit. If the care you are seeking is primarily clinical, you will need a licensed professional to provide this expertise.

Now that you know the benefits of case and care managers, you may be curious to try one out.

The easiest way is to contact your health insurer’s customer service department. Ask them if they have care or case managers, confirm it is covered under your plan and request credentials. To guide the customer service agent, specify the types of services you are interested in and who performs them—this will help connect you to the best manager for your personal health journey.

Above all, case and care managers are like tour guides to your treatment. They serve as your advocate and search for ways to make treatment easier and more accessible each day. If you have any questions regarding the role of care managers in Saisystems Health’s chronic, oncology and CMS OCM programs, please reach out to our dedicated representative, Sam, at smanns@health.saisystems.com.

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