How case managers help navigate your health care

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Do you ever feel like there aren't enough hours in a day? With a complex diagnosis or severe health condition, coordinating your care on top of your daily responsibilities can feel like a full-time job. For Wellmark Case Managers, it is!

The Wellmark Case Management program offers confidential, personalized support to members with complex or severe health conditions like cancer, heart disease and diabetes, as well as behavioral health and pregnancy support. Wellmark members can refer themselves to case management, be referred by their provider or Wellmark when claims data shows signs of a serious or complex condition.

Spend a day with Wellmark Case Management nurses, Jessi and Stacy, and see all the ways our case managers can support you.

Here’s a day in the life of a Wellmark Case Management nurse

Starting the day

Stacy is a case management nurse for complex case management. While working as a registered nurse in a hospital, Stacy was always concerned about what would happen to her patients after they left her care. As a Wellmark Case Manager, Stacy gets to be with a member throughout the entire care process — well beyond discharge from the hospital.

Here’s what a typical morning looks like for Stacy.

I start the day by checking for messages left by members overnight. I call each member, and I answer questions about blood pressure and glucose readings, help a member prep for an upcoming procedure and listen as a member talks through their feelings about a recent scan. I help with whatever the member needs or connect them with another resource who can assist.

The healing power of personal connection

Jessi is a case management nurse who assists pregnant members who belong to the Federal Employee Program (FEP). As a perinatal nurse case manager, Jessi supports expecting members and their babies throughout their entire pregnancy, in the postpartum period, and beyond — which helps them build a strong personal relationship.

Jessi goes to work right away building a personal connection with the members she supports.

I do some research about these members by looking at their claims information and start my outreach calls. During this call, I introduce myself to the member and talk to them about how case management can help them have a healthy pregnancy and a successful postpartum journey. Establishing a personal connection builds trust and helps members feel supported in the ways they need. While each day is different, I’ll typically call anywhere from 10 to 20 members in a day.

I also have scheduled calls to check in with members. I check in with each member at least once a month, but depending on their case or condition, I might check in more often.

Stacy regularly helps members with conditions like diabetes or cancer stay on top of their care and work toward their health goals.

These are some of the topics Stacy might talk about with a member during a check-in call.

During these calls, I see if members are staying on top of their prescription regimen, doing their physical therapy exercises, following their diet or just going to their appointments. Members can also ask me questions or talk through any issues they’re experiencing. Sometimes they’ll just need to talk, and I’ll listen and offer encouragement or advice.

Finding resources to ease your journey

Both Jessi and Stacy work hard to provide the members they support with the resources they need to be safe, healthy and successful.

Stacy typically helps members secure resources like financial assistance to help with the cost of medications, transportation to and from appointments or medical equipment. She also can provide educational resources like diet and exercise programs for a member’s specific condition.

I can also refer members to Wellmark-provided resources if they have questions about their benefits, claims or need help finding in-network care. If a member asks a question and I don’t know the answer, it’s my job to find someone who does. I know navigating health insurance can be confusing or anxiety inducing, which is why I do my best to help in whatever way I can.

Jessi shares those same resources with members — and more.

A big part of my day is finding resources for members. While most of the resources I provide are educational, I can also help connect pregnant members to social workers, mental health therapists, state programs that provide affordable housing, lactation specialists, prenatal birthing classes near the member or get them a free breast pump through their insurance benefits.

Collaborating for your success

As case management nurses, Stacy and Jessi understand how to navigate the health care system and use that knowledge to help members get the care they need. By collaborating with members’ health care providers, Stacy and Jessi can make sure members are set up for success.

Here’s how Stacy might work with a member’s health care provider following a hospital stay.

One member was recently admitted to the hospital and will need care following discharge. After talking with the discharge team at the hospital, I was able to communicate the discharge plan to the member and ensure the member connected with the home services arranged and had no barriers to their treatment plan after discharge. I was able to help the member arrange transportation to a follow up appointment they would have missed otherwise.

Jessi also connects with a member’s health care provider, when necessary.

During a phone check-in with an expecting member, I noticed their emotional health wasn't the same as in previous calls. I asked them a few questions about their mental health and the member scored high in their depression and anxiety screening. After receiving permission from the member, I contacted their health care provider and requested the provider talk to the member about their mental health at their next appointment which was scheduled in a few days. This member was able to discuss their emotional health concerns with their provider and a treatment plan was started.

Logging off

After a day of checking in, resource searching and community building, Jessi and Stacy typically end their day.

At the end of the day, I update my notes for all the members I spoke to throughout the day and write down reminders. I review my calendar one last time, then log off for the evening.

Be ready to answer the call

Case management services are included in most Wellmark plans, cost you nothing and are confidential. Keeping your contact information current in myWellmark ensures a case management nurse or social worker can reach you when you receive a complex diagnosis and need some extra support. To make sure your contact information is up to date, log in to myWellmark.