When a member is diagnosed with complex health problems, a SummaCare Care Manager monitors the clinical care the member receives.
Care Managers are registered nurses who assist members by helping with transitions between hospital and home or other care settings and help members access needed health and support services. Also, a member of the team is a licensed social worker who can assist with finding community resources, transportation or provide support during illness, domestic conflicts or abuse.
This program is available to high-risk expectant moms. Assistance is provided to support the health of the mother during pregnancy and right after the birth of the baby. Pregnancy and newborn care education is available as well as assistance with referrals to community resources. Enrollment is at no cost and confidential.
Care management services may be short-term for members who are transitioning home after a hospital stay or who are new to our plan and need help finding new in-network providers.
Care management services may be long-term for members with catastrophic or highly complex problems. For members with complex needs, SummaCare Care Managers will assist in understanding the condition and will coordinate arrangements for complicated plans of care. The SummaCare Care Manager stays in touch with healthcare providers and other caregivers and provides assistance with finding needed care within the plan network.
In the event that a SummaCare member reaches the plan limits on certain types of care, a SummaCare Care Manager is available to help the member find other resources.
A Care Manager is available to help SummaCare members arrange for adult care during a transition from child/adolescent needs to adulthood. Our provider search is also available to help find a new provider for someone entering adulthood.
SummaCare’s Care Management programs are available at no cost to you. To learn more about or to enroll in SummaCare’s Care Management Programs, call 330.996.8931 or 877.888.1164 (TTY 711) 8:30 a.m. to 5:00 p.m. EST. Enrollment is optional and you may opt out at any time.