Our nurse clinicians are supported by the most advanced technologies in order to assist clients in improving their health and to impact the risk related to their members’ clinical outcomes.
We help members build the skills and personal habits they need to make lifestyle improvements that increase their quality of life, prevent chronic conditions and reduce healthcare costs. How? We build personal relationships, blending the best of behavior change methodology with clinical expertise to empower members to be better managers of their health.
Telephonic Triage – We Are Always There
The Nurse Line is available 24/7, 365 days a year and serves as a basic foundation for many of the other internal programs available at Carewise Health. The Carewise Health Nurse Line is a service that provides accurate, consistent medical information using physician authored clinical guidelines.
The program provides:
Telephonic triage and health counseling delivered by registered nurses with certification in telephone triage
- Self-care and/or home treatment instructions
- Guidance on when to seek care and the time frame needed
- Assistance finding a medical home or in network facility
- Escalation to Emergency Services
General health information, shared decision making, prevention, lifestyle counseling and assistance in navigating an often confusing health care system. We’ll answer questions and email free additional information. The nurses can also connect callers to recorded information concerning hundreds of topics
Navigational assistance and collaboration with other benefits available to the member, such as finding an in network provider or facility and referrals to other client specific programs that would be of value to the members
Partnerships to assists members make better health care choices
Translation services in over 145 languages
Health Advocacy – Care Coordination
When members are feeling fine, our Nurse Line can help keep them that way. When there are questions about health topics (nutrition, prenatal care, smoking cessation, etc.), the nurses help with resolving health issues in a timely manner.
Sometimes it’s hard to know which to choose- call the nurse, urgent care or ER – but there’s a big difference in time and money. After-hours nurse support is valuable by providing advice when the regular doctor’s office is closed or when members just aren’t sure what to do. We’ll, for example, get a call in the middle of the night about a crying baby. Our nurses help decide next steps. The nurse’s calm, reassuring voice can make all the difference. The nurse will ask the right questions and listen to concerns. We’ll help members choose where and when to get treatment, or provide information on treating a minor illness or injury at home.
A nurse can provide assistance if needed on locating an in-network facility such as urgent care or ER. In the event of a true emergency, callers will be instructed to call 911 or their local emergency number.
The nurse will follow up with the member to ensure the problem is being resolved and may refer them to other programs and services for a more holistic experience and coordination of care. The nurse line is the first point of contact in reviewing the member’s overall health and promoting programs and resources that would bring additional value to their overall health and wellness.
Healthier day-to-day lifestyle
With so many hours spent at work and so many demands on our time outside of work, it’s no wonder worksite wellness is gaining popularity. Onsite programs are convenient for employees. Carewise Health’s Worksite Wellness program unifies all your initiatives to promote good health as a way of life. Employers make significant investments in health programs for their employees, but it’s a challenge to achieve and sustain interest and participation. Our one-on-one coaching by telephone can complement these services.
Members sign up for six- or eight-week sessions supported by onsite coaching and curriculum activities. Sessions include:
Nutrition Stress management Smoking cessation Weight management Walking for exercise
Better Culture
Worksite Wellness builds a workplace culture of good health. Never underestimate the power of coworker support. Worksite Wellness is a powerful way to demonstrate your commitment and drive excitement and engagement in all health programs. Because some employees enjoy interacting with a group of like-minded individuals, group support is a key element of the program When an individual has a personal interaction and expresses an interest in better health, he or she is much more likely to participate in other health-related programs.
Carewise Health Utilization Management services are a gateway to medically appropriate services for members.
Types of Services
Carewise Health Utilization Management is a gateway to medically appropriate services for members.
- Pre-certification: Carewise Health evaluates medical appropriateness by applying standard guidelines or by having the proposed service reviewed by an on-site medical director. For services not certified, expedited and standard appeals also are provided.
- Concurrent Review: Carewise Health monitors the treatment delivered to the member on each day of hospitalization, along with the member’s response to treatment and health status
- Discharge planning: Prior to discharge, the nurse identifies the resources and support that will be needed to ensure a safe transition to home recuperation
- Care coordination: If a member will need rehabilitation services, sub-acute care or home-care services after discharge, Carewise Health will identify qualified network providers, make the necessary arrangements and monitor that the therapeutic intent of service is being met
Early referral of high-risk cases: If used as part of a total health-management solution, Utilization Management will refer members with acute recovery risks to Carewise Case Management at the time of pre-certification. Additionally, those members with chronic conditions will be encouraged to take advantage of Disease Management resources and engage with a Carewise nurse as soon as it is appropriate.
Population-based utilization profile: We will conduct a detailed claims analysis of the last 24 months to identify variances from industry benchmarks and opportunities to reduce over-utilization. This profile becomes the foundation for a strategy that is uniquely appropriate to your population.
Our Staff
Utilization Management reviews are performed by registered nurse specialists with diverse clinical backgrounds. Nurses working in this team have medical-surgical experience and direct knowledge of accepted clinical practice guidelines, proactive procedures, discharge planning, concurrent planning, precertification, and clinical case appeals. They understand quality, risk, and cost concerns in the provision of patient care. By coordinating health care benefits, they ensure patients are receiving quality care at the appropriate level, and at the least costly but most effective treatment benefit.
Accreditation
Our case management programs are accredited by URAC. URAC’s mission is to promote continuous improvement in the quality and efficiency of healthcare management through processes of accreditation, education, and measurement. Carewise’s program is accredited in nine core disease states as defined by the Disease Management Association of America.
With the right support, people with chronic diseases or conditions can learn how to manage their symptoms and even slow the progression of their illnesses. They can become the best versions of themselves with support from Carewise Health’s disease management team.
Carewise Health’s Disease Management team is staffed by Registered Nurse Specialists
Registered Nurse Specialists provide one-on-one telephonic support that builds a personal relationship with the member. They help members develop self-care skills and establish new health habits that will have a lasting impact. Members learn how to overcome the specific daily challenges they face in following their physician’s treatment plan, taking medications as prescribed and putting healthy lifestyle behaviors into practice. Members learn the lifelong skills they need to manage their condition for the long term.
Education
Everyone faces a unique set of obstacles to achieving what is best for their health. We provide friendly, award-winning materials that help them take the steps that lead to a higher quality of life. The engaging curriculum is based in behavioral science concepts proven to build motivation and confidence and prepare members to make successful lifestyle changes. Members can also receive quarterly communications specific to their chronic condition that highlights healthy behaviors and showcases inspiring stories.
Carewise Health Case Management services are a gateway to supportive and coordinated care when members face serious medical issues.
Partner in Health
When a member experiences a serious injury, illness or surgical treatment, a partner in health can make all the difference in achieving a recovery that is as quick and cost-effective as possible.
Our Case Management Team
The Case Management team consists of Registered Nurses Specialist with expertise in a variety of clinical areas. They provide support to members who may have been hospitalized or may be undergoing treatment for a serious illness. They can work with the member, their family, and their doctor to coordinate a plan and identify resources to meet their needs.
The maternity program focuses on the needs of the expectant mother during a period of great physical and emotional changes.
Comprehensive Program
The Maternity Management program is tailored to address topics and concerns that are important to expectant mothers, such as weight gain, exercise limits, dental hygiene, doctor visits, medical procedures, and medications, symptoms of pre-term labor, family support and depression. By providing timely, individualized education and support to members, the maternity nurses address risks that contribute to pre-term births, pregnancy complications and lengthy hospital stays. These educational resources help mothers care for their own health and the health of their growing families.
Managing Changes
Our Registered Nurse Specialists focus on supporting the expectant mother during this time by providing education on changes that are occurring, how to manage some of the changes such as weight gain, nausea and vomiting, ankle swelling just to name a few. The Registered Nurse Specialists provides specialized education for mothers considered high risk associated with pre-term labor, pregnancy complications and lengthy hospital stays. They address individualized concerns and questions in preparation for delivery. They also support the mothers as they transition to home with their infants with a postpartum call to assure a smooth transition and to address any questions that arise about infant feeding and general care, family adjustments and screening for postpartum depression.