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Case Management

For MembersCase Management


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 managing conditions and situations such as:

  • • Pregnancy-related problems
  • • Asthma
  • • Diabetes
  • • Transplants
  • • Multiple hospital and emergency room visits
  • • Getting needed services
  • • Finding help in the community for needs that your health plan does not cover

Special Health Care Needs

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

Our case management team may reach out to invite you to join these programs and services after looking at your health claims. You may also sign up or opt out at any time. You can email or call the number listed on your member ID card.

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).

Healthy Pregnancy Information

Expecting the Best® Maternity Program

Scott and White Health Plan is pleased to offer Expecting the Best® for our members. This program is focused on helping mothers enjoy a healthy pregnancy. Expecting the Best® members will receive helpful tips and assistance during pregnancy and for one year after birth.

  • • Planning for delivery, including individual support during and after a pregnancy
  • • Access to a nurse 24 hours a day, seven days a week
  • • Coordinated efforts to promote full-term birth in women who previously delivered pre-term
  • • In-home support for high-risk conditions such as diabetes, hypertension and severe nausea
  • • Early enrollment in case management support program
  • • Depression screening following delivery, including postpartum resources
  • • Parental education for newborn health during the first year
  • • Immunization reminders
  • • Planning for returning to work

Sign up by calling the customer service number on the back of the member's insurance card or email us. Please include:

  • • Name
  • • Preferred phone number
  • • FirstCare member number
  • • Brief description of needs or risk factors

A Case Manager may invite you to enroll when we receive a doctor’s referral or pregnancy claim. You can opt-in or out of this program at any time through a Case Manager or customer service.

View informational flyer.

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).