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Member Services Phone Number 888.301.1228

Care Management

GCHP Care Management is a collaborative process that includes telephonic contact with the member and communication with the medical management team, led by the primary care provider. 

Members eligible for care management services may include those with:

  • Multiple medications and difficulty with adherence
  • Non-adherence to the medical treatment plan
  • Psychosocial barriers that may prevent progress
  • Resource barriers and need assistance from a social worker
  • Organ transplant
  • High risk pregnancy
  • Catastrophic or medically fragile conditions
  • Frequent hospital admissions
  • Frequent emergency room visits for non-emergent care
  • Coordination of care issues

Care Managers accept referrals from plan providers, hospital case managers, self-referrals from members and community agencies.

The care management process includes:

  • Assessment
    • Individual needs based on a comprehensive evaluation
    • Barriers to adherence with treatment plan identified
  • Planning
    • A member-centric care plan is formulated based on member understanding
    • Opportunities for improvement, goals and collaborative approaches to evidence-based interventions are explored
  • Coordination
    • Coordination of care and integration of services across a range of settings
    • Collaboration with member, family, member’s representative, primary care physician and other members of the health care team
  • Monitoring and Evaluation
    • Reassessment to determine if desired outcomes and goals of care plan have been met is done per member and care manager agreement
    • Revisions to the care plan are consistent with the dynamic needs of the member
  • Advocacy
    • The care manager serves as a member advocate by providing support and education to empower members and families to become self-reliant in managing the disease process
    • Care managers practice cultural sensitivity and work effectively within the member’s cultural context

Click here for the GCHP Care Management referral form. This fillable form can be completed and emailed to caremanagement@goldchp.org or faxed to 855.883.1552.