Member Benefits

Care Management from a Team of Specialists—Support When You Need It Most

As part of your health benefit plan, you have access to care management—a voluntary program to help you and your family deal with chronic or serious illnesses or injuries. This program is available to you at no additional out-of-pocket cost.

How Care Management can help

When you use the care management nurse, extender or behavioral health specialist you get the right care at the right time in the appropriate environment. They help by:

  • Answering your health-related questions
  • Coordinating care between multiple doctors
  • Helping you understand conditions
  • Supporting you through lifestyle changes to help manage conditions
  • Supporting you throughout your illness, from beginning to recovery
  • Helping you make sure all your healthcare needs are met, providing you with a holistic approach and offering resources available to your specific needs

Support for medical conditions and diagnoses

When you or a loved one is sick, hurt, or dealing with a new diagnosis, trying to navigate the healthcare system can be overwhelming. Your care management team can help you understand your benefits, answer care questions, and even find high-quality, cost-effective providers in your plan’s network. Your care management nurse can help with many diagnoses, including:

  • Cancer
  • Respiratory illnesses
  • Heart conditions
  • Behavioral health conditions
  • Injuries or emergency hospitalizations
  • Pediatric conditions
  • New diagnosis
  • Recent elective or non elective surgeries

Transitions of Care/Continuity of Care

At OhioHealthy, we understand switching health plans can feel overwhelming. One of the most common obstacles to switching plans is the ability for individuals to maintain a relationship with their current physician. OhioHealthy makes healthcare easier, because it should be. Guided by the OhioHealthy Care Management team, our transition of care (TOC) and continuity of care (COC) programs are uniquely designed to prevent disruption of approved covered services.

Why it's important

  • Prevents interruption of ongoing treatment.
  • Ensures the continuation of clinical care and/or other approved services for a limited period once enrolled.
  • Members have 30 days to complete the pre-certification for COC form.
  • Members have up to 90 days for TOC.

Working across the healthcare ecosystem, our clinical care management team supports each member’s individual needs by:

  • Assessing immediate and long-term care needs.
  • Finding network providers within their desired geography.
  • Scheduling appointments with primary care and/or specialists within the OhioHealthy network.
  • Assisting with additional transition needs.
  • Providing access to community resources.
  • Reviewing benefits and providing answers to frequently asked questions.

Take the First Step Toward Better Health

Contact OhioHealthy Care Management at (614) 485-7941 or CareManagement@OhioHealthyPlans.com to learn more.