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Case Management

For MembersCase Management

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What is case management? 

Case management is a process that allows us to help you manage your healthcare. How? By providing you with timely information and resources. Your case manager will make sure you get the services you need. They will also show you how to find and get other services.


Our case managers include experienced nurses and social workers who will help you with:

  • Pregnancy-related problems
  • Asthma

  • Diabetes

  • Transplants

  • Multiple hospital and emergency room visits

  • Getting needed services

 

Special Health Care Needs

If you have special healthcare needs — such as chronic conditions, serious ongoing illness, or a disability —  your case worker can:

  • Help you get specialized care and services, including scheduling appointments
  • Develop a plan of care with you and your doctor

  • Answer your healthcare questions


Behavioral/Mental Health and Substance Abuse

Your complete wellbeing is important. Your case manager can help you get care if you:

  • Feel very sad, stressed, or worried
  • Can’t deal with daily life
  • Aren’t sleeping or eating well
  • Have thoughts about wanting to hurt yourself or others
  • Are troubled by strange thoughts (like hearing voices)
  • Are using drugs or drinking alcohol more
  • Have problems at work or at home
  • Have a child with problems at school

For a Behavioral/Mental Health Case Manager, call 1-855-395-9652.


Farm Workers and Migrant Workers

Children of migrant workers have special health care needs. Our case managers will help members get the care they need right away. They will also help with scheduling doctor visits and getting checkups sooner if you are leaving the area.

Call us at 1-855-TX-RIGHT (1-855-897-4448).


Quality Improvement Program

We want to get better at helping you get better. Our RightCare Quality Improvement (QI) Department helps us do that. Using data to measure your health needs, we can create better programs for diabetes, asthma, heart disease, immunization (shots), and women’s health. To learn more about our QI goals, processes, and outcomes, call us at 1-855-TX-RIGHT (1-855-897-4448).