Common use of CARE COORDINATION AND CASE MANAGEMENT Clause in Contracts

CARE COORDINATION AND CASE MANAGEMENT. 4.11.7.1 The Contractor shall be responsible for the Care Coordination/Case Management of all Members and shall make special effort to identify Members who have the greatest need for Care Coordination, including those who have catastrophic, or other high-cost or high-risk Conditions. 4.11.7.2 The Contractor’s Care Coordination system shall emphasize prevention, continuity of care, and coordination of care. The system will advocate for, and link Members to, services as necessary across Providers and settings. Care Coordination functions include: 4.11.7.2.1 Early identification of Members who have or may have special needs; 4.11.7.2.2 Assessment of a Member’s risk factors; 4.11.7.2.3 Development of a plan of care; 4.11.7.2.4 Referrals and assistance to ensure timely access to Providers; 4.11.7.2.5 Coordination of care actively linking the Member to Providers, medical services, residential, social and other support services where needed; 4.11.7.2.6 Monitoring; 4.11.7.2.7 Continuity of care; and