Case Management: Transplant
Prairie States’ Case Management Nurses ENGAGE, GUIDE & ADVOCATE
For members facing life-threatening illness, an organ transplant brings a fresh start and renewed hope. The transplant process, however, can be complex and daunting. Prairie States’ skilled RNs intervene early and engage closely with a definitive purpose: ensuring the highest level of member care for the best possible outcome – while always keeping an eye on savings.
Other third-party administrators rely on outside care management programs. Prairie States’ Case Management Nurses have been tracking transplant cases for our customers’ health plans for over 30 years. Our in-house team of Case Managers works side-by-side with our claims staff, in real time, on the same claims system. Every claim comes to us, so we see the entire picture, and share it. This integration of services and data allows our nurses to provide seamless, detailed and more timely responses throughout the transplant process.
Our case managers help control volatile transplant costs for health plans while giving members nationwide access to best-in-class transplant providers. We provide greater cost predictability from treatment through recovery by:
- Assessing the member’s health and wellness needs to develop an individual care plan
- Helping to identify providers based on member needs, location, and cost
- Assuring that appropriate prior authorizations for transplant services are in place
- Working with transplant policy contracts and stop loss carriers to manage costs and reimbursements
- Setting wellness goals including a timeline and expectations
- Assisting with medication questions, ensuring adherence to the prescribed treatment plan
- Helping patients with symptom management, always focused on the path to recovery
- Steering members away from costly ER visits and readmissions while making sure needs are met
Our RNs foster an environment of healthy communication, leading to better care, understanding, and management. From initial transplant consideration through post-transplant follow-ups, Case Management keeps the patient at the center, helping members and their families with every step, and through every challenge.
At Prairie States, we know that a transplant can be life-altering procedure. Our experienced, caring team of Care Management nurses is dedicated to ensuring that no member goes through the experience alone. From diagnosis and treatment through to recovery and ongoing wellness checks, our team is always by the member’s side.
Prairie States Enterprises, Inc. is a third-party health benefits plan administrator that brings industry expertise and a clinical focus to self-insured companies. Our in-house claims administration, health management services, wellness programs, plan analysis and predictive modeling tools result in remarkable and unprecedented cost control for employers. We also provide the most compassionate and personalized level of service for plan members.