Pro Care Health Plan, Inc. provides case management services for a variety of reasons i.e.:

1. 10 day or greater length of stay in hospital
2. Readmission is less than 15 days after discharge or more than (1) one admission within a 4 month period
3. Newly diagnosed disorders resulting in a change of lifestyle
4. Prolonged or frequent inpatient treatments and / or outpatient services
5. Major change in current level of care or services
6. Current level of care is not appropriate for the illness episode
7. High risk pregnancy
8. Terminal illnesses
9. Chronic disorders (examples listed but not limited to):
   • Organ transplants
   • Renal failure
   • Neonatal ICU
   • Trauma with multiple disabilities
   • Asthma with high admissions
   • Diabetes w / HgbA1c >9.0
   • Severe behavioral health problems
   • HIV / AIDS
   • Severe respiratory conditions

If any members need case management services, submit the following referral form.