Personalized healthcare guidance from healthcare professionals.
The Medical Service Department of Community Health Partners is URAC Accredited in Utilization Management. Our local diverse staff of Certified Case Managers, RNs and LPNs has the ability to respond uniquely to each individual’s healthcare needs, to arrange services with quality providers that are consistent with their benefit plan, and to help facilitate quality and cost effective outcomes.
Medical Services
WorkCare
We Work for You!
Our goal is to improve timeliness of care, improve employee and employer satisfaction, reduce workers compensation cost to the employer while assisting injured workers through the path of medical treatment for their work injury.
Case Managers:
-
Provide education and timely information to the injured worker and their family.
-
Monitor treatment guidelines and patient progress.
-
Provide frequent contact by the nurse case manager to schedule appointments for tests, therapy and follow up appointments and address any concerns regarding their physical injury.
-
Provide ongoing communication with providers, employer and insurance adjuster.
-
Are available 24 hours per day/7 days per week for urgent matters.
Our case managers work with employers to facilitate early return to work, encouraging accommodation of modified duty. Utilizing the resources of our comprehensive network of providers, treatment can begin within 24 hours of the injury or as soon as medically appropriate. Our internal guidelines are implemented to expedite treatments for the injured worker and return them to full function as quickly as possible.
WorkCare is integrated with our medical services solutions and can benefit your employees and your bottom line.
More Information
Call (239)594-8000 between 8 am – 4:30 pm, Monday-Friday.
Case Management
Personalized Healthcare Guidance from Healthcare Professionals
Case Management professionals provide customers with professional healthcare guidance on a 1:1 basis. Whether a customer is living with a complex disease or has a healthcare question, registered nurses certified in Case Management work directly with the individual and his or her providers to meet health needs through direct communication and the use of available resources to promote quality, cost-effective outcomes.
Common health issues that benefit from Case Management include:
-
Newly diagnosed conditions
-
Catastrophic injuries/illness
-
Cancer
-
Organ transplants
-
Chronic renal failure
-
Liver disorders
-
Diabetes with complications
More Information
Call (239)659-7770 between 8 am – 5 pm, Monday - Friday.
Utilization Management
A Medical Services Solution with Benefits for your Employees and Your Bottom Line
The Utilization Management Program evaluates and manages the quality and cost of healthcare services delivered to customers of Community Health Partners. A local staff consisting of physician medical advisors, registered and licensed practical nurses review inpatient and outpatient services to determine medical necessity, utilizing “gold standard” clinical criteria. Authorization turnaround time is 1-2 business days, depending on receipt of appropriate documentation to substantiate medical necessity.
Program components include:
-
Pre-admission and admission review.
-
Concurrent hospital stay review.
-
Case Management and Disease Management (SmartChoice).
-
Referral authorization for a specialist or out-of network care.
-
Outpatient service and ambulatory review.
More Information
Call (239)659-7770 between 8 am – 5 pm, Monday - Friday.
Click the forms button below to fill out the pre-certification request form and fax it to (239)659-7785.
Baby and Beyond
Education, Support, and Early Identification of Risks to Help Expectant Mothers Achieve a Full-Term Pregnancy
The Maternity Care Coordinator (OB/GYN Registered Nurse) works with your healthcare provider to
-
Provide support to maximize your medical care
-
Help you understand and comply with treatment plans
-
Offer assistance with resources and special services when requested
-
Answer questions about your pregnancy
Expectant mothers don’t just face physical changes. That’s why we also provide emotional support with regular contact throughout your pregnancy. Your coordinator is just a phone call away to answer questions and listen to your concerns during regular business hours Monday-Friday 8:00am-4:30pm. Educational materials are provided for expectant mothers and their significant others.
Members may seek help to manage such common issues as:
-
PIH or Pregnancy Induced Hypertension
-
Gestational diabetes
-
Kidney disorders
-
Preterm issues (spontaneous delivery before 35 weeks)
-
Tobacco use
-
Postpartum depression
Baby and Beyond is a Community Health Partners medical services solution that can benefit your employees and your bottom line.
More Information
Call (239)659-7770 between 8 am – 5 pm, Monday - Friday.
