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Case Management

Our case management program is designed to assist members in evaluating their current health care needs. A case manager will work with a member and the member's health care team to coordinate services to meet needs in a quality and cost-effective manner. Based on the member's Blue Cross and Blue Shield of Kansas contractual benefits, the case manager also will research resources that promote quality and cost-effectiveness health care.

Situations that may benefit from the case management program could include but are not limited to:

  • Complex wound management
  • Head injuries and strokes
  • High risk pregnancies
  • Multiple trauma
  • Palliative and end of life care
  • Premature/High risk infant
  • Progressive neuromuscular diseases
  • Severe burns
  • Specialty drugs
  • Spinal cord injuries
  • Transplants
  • Ventilator dependency

Our case management program emphasizes educating members about their current health status and in collaboration with the member and their health care team, coordinates services to meet the members' complex needs including:

  • Assisting members/families with concerns regarding their health care needs and benefit plan
  • Provides self management support to members
  • Identifying appropriate sites for services
  • Facilitating access to contracting providers
  • Assisting with discharge planning services
  • Assessing available community resources

How does the program work?

Referrals are received from multiple sources such as the member, family or caregiver, physician or other health care providers, or employers.

When a referral is received, the member’s current needs, medical history and available medical benefits are evaluated.

The case manager provides information to the member on the cost efficient use of benefits, potential alternative use of benefits and/or coordination of existing benefits.

The case manager works with the member/family, physician and other members of the treatment team in the development of a plan.

Rights and Responsibilities

Would you like more information?

If you would like a copy of the program description, the rights and responsibilities in Spanish, or further information regarding the case management program, send your request/comments to CMManagers-AT-bcbsks-DOT-com or call 1-800-432-0216, ext. 6628.

Participation in the case management program is free and voluntary, and the member may elect to withdraw at any time. Any information gathered during the course of the program will remain strictly confidential.

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