Care Management
We help members get the right support earlier, manage ongoing health needs with more confidence, and make benefits work harder for the people and employers counting on them.
Comprehensive healthcare experiences
Our Care Management solutions are designed to work together. We help identify risks earlier, guide members through complex care, support chronic condition management, and encourage healthier habits year-round.
The result is a more connected experience for members and a smarter, more proactive way to manage plan performance.
Utilization management
Guide care decisions with confidence
We help ensure members receive appropriate, high-quality care while supporting cost control and plan alignment.
Case management
Support complex care before costs escalate
We provide nurse-led coordination for members with complex, chronic, or high-risk needs.
Chronic management
Help members manage ongoing health needs
We support members managing ongoing conditions with education, outreach, and personalized guidance.
Wellness programs
Keep employees engaged in healthier habits
We help employers engage their workforce through coaching, education, wellness challenges, and practical tools for healthier living.
Telemedicine
Make care easier to access
We help members connect with licensed providers for common, non-emergency health needs, giving them a convenient way to get support earlier and make better use of their benefits.
Utilization Management
We help reduce unnecessary utilization while supporting appropriate, high-quality care. Our RN-led review process uses validated clinical criteria, provider collaboration, and real-time insights to help plans manage cost without creating unnecessary barriers.
9.1 ROI
on utilization management
Smarter reviews. Stronger savings. Better care decisions.
Experienced RN team and board-certified physician reviewers
Specialized nurse teams across areas such as oncology, transplant, behavioral health, pain management, and infusions
Validated clinical criteria, including MCG, NCCN, ASAM, AACAP, and APA
URAC-certified and quality-standard aligned
Pre-certification & prior authorization
We review elective procedures, inpatient admissions, and specialty care to support medical necessity and alignment with plan coverage.
Concurrent review
We provide ongoing assessment of inpatient stays to support appropriate length of care and timely discharge planning.
Discharge planning & transition support
We help coordinate safe, cost-effective transitions from a facility to home or an alternate care setting.
Provider & member engagement
We support clear communication and clinical collaboration, with bilingual support available.
Reporting & analytics
We provide real-time insights into utilization trends, cost drivers, and health outcomes.
Case management
Complex and chronic conditions can create the greatest concern for employers, members, and families. Our Case Management program provides proactive, nurse-led coordination, early intervention, and actionable insights to help improve member health while supporting smarter cost management.
$15,225
Average case management cost savings for engaged members
4.5 CM ROI
21.0 ROI for transplant
3.5 ROI for high-risk maternity
3.5 ROI for oncology
Nurse-led clinical oversight
Our experienced RNs identify high-risk or complex cases and provide support for members managing chronic conditions, catastrophic events, and post-discharge care needs.
Member advocacy & education
We provide personalized guidance to help members navigate care and improve self-management of high-risk conditions.
Utilization management integration
We help ensure the appropriate use of services in network and in accordance with the plan document.
Real-time monitoring & reporting
We track member progress, identify high-cost trends, and deliver actionable insights.
Group coaching
We partner with employers and stop-loss carriers to help improve outcomes.
Chronic management programs
Managing a chronic condition takes more than a one-time conversation. We provide consistent, nurse-led support to help members better understand their health, stay engaged in their care, and take practical steps toward improved well-being.
With an average annual medical cost savings of $7,401 per managed member, our programs support better health decisions while helping employers manage long-term healthcare costs.
Chronic disease management
We support members managing asthma, diabetes, hypertension, and high cholesterol with nurse-led calls and guidance.
Prevention programs
We help members stay proactive with programs for Uplift, Mom-to-Be, nicotine cessation, and cancer screening.
Additional services
We offer biometric screenings and health risk assessments to help identify risks and guide support.
Chronic disease management
We support members managing asthma, diabetes, hypertension, and high cholesterol with nurse-led calls and guidance.
Prevention programs
We help members stay proactive with programs for Uplift, Mom-to-Be, nicotine cessation, and cancer screening.
Additional services
We offer biometric screenings and health risk assessments to help identify risks and guide support.
Wellness program solutions
We help employers build healthier, more connected workplaces through practical tools, expert guidance, and motivating wellness experiences.
From educational resources to group coaching and quarterly challenges, we give members approachable ways to build healthier habits that fit into everyday life.
Engaging challenges
We create wellness competitions that motivate employees to take action.
Expert webinars
We share insights from thought leaders, including voices like Olympian Scott Hamilton.
Toolkits
We provide ready-to-use resources that spark conversations around health and safety
FreshAir newsletters
We keep wellness top of mind with seasonal tips, stories, and timely health content.
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Group coaching
We connect members with certified wellness coaches through monthly Zoom sessions, email check-ins, and practical tools to improve nutrition, sleep, stress, and overall well-being.
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Telemedicine
Not every health concern needs a waiting room. We help members access convenient virtual care for everyday needs, giving them a simpler way to get support earlier and make better use of their benefits.
Through our telemedicine partner, members can connect with board-certified physicians and access support across general medical care, mental health, dermatology, and nutrition services. It’s a practical way to improve access, support satisfaction, and help members use the right level of care at the right time.
24/7 virtual care access
Members can connect with care anytime, anywhere for many common, non-emergency health needs.
General medical support
Virtual visits can help with everyday concerns like cold and flu symptoms, infections, allergies, and other routine needs.
Mental health care
Members can access therapy, psychiatry, and ongoing behavioral health support when included in the plan.
Dermatology support
Virtual dermatology can help members get care for skin concerns such as rashes, acne, and other common conditions.
Nutrition services
Members can receive personalized diet and wellness support to help build healthier routines.
Prescriptions and follow-up
Virtual care can support prescriptions when appropriate and help members understand next steps after the visit.
Faster time to care
through a national virtual provider network
Our care management process
Better support. Better insight. Better outcomes.
We bring our Health Management solutions together to help employers manage plan performance while giving members the support they need to take the next step in their health journey.
Ready to strengthen your Care Management strategy?
We’re here to help you build a Care Management approach that supports members, strengthens plan performance, and creates measurable value.
