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Medica Administrative Manual > Health Management and Quality Improvement > Care Management

Care Management

Adult Complex Case Management Program: Information on the Adult Complex Case Management Program for members in complex or acute situations.

Advanced Illness Program: Information on Medica’s Advanced Illness Program for members facing life-limiting illness.

Behavioral Health Program: Information on the Medica Behavioral Health (MBH) Program for members who live with a mental illness and or experience emotional and functional disruption due to a life event, recent loss or exposure to trauma.

Benefit Appeals: The appeals process and provider's role.

Kidney Care Program: Information on Medica’s Kidney Care Program for members with late-stage chronic kidney disease (CKD) or end-stage renal disease (ESRD).

Pediatric Case Management Program: Case management of infants or children with special needs.

Pregnancy Program: A family-centered model that supports the health of pregnant women and their babies in partnership with the health care provider.

Transitions of Care Program: Information on the Transitions of Care (TOC) program for members who are at risk of readmission.

Transplant Case Management: Management of prior authorization requirements for appropriateness of transplant, network status of facility for best member benefit and pre and post transplant services that may be needed by the member.

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