Case Management
Mutual of Omaha’s Case Management program assures better outcomes for plan members with conditions that lead to extended, highly specialized or resource-intensive care.
Members are identified for our Case Management program through our predictive modeling system that projects a member’s future burden of illness, Utilization Management program and Claims and Customer Service areas so that earlier referrals to our Case Management program can be made. Our goal is to determine plan members who need specialized support and get them the treatment they need before they become large dollar claims.
Our Case Management program:
- Navigates members through the continuum of care
- Educates members on their medical condition
- Facilitates an appropriate use of plan benefits to minimize the financial impact to the plan and a member’s out-of-pocket costs
Promotes compliance with treatment protocols and evidence-based medicine
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