Case Management

As a member of Western Health Advantage (WHA) you may receive help getting the care you need from an experienced case management (CM) nurse. If you qualify for Case Management program services, usually because you have complex healthcare needs, you will be provided individual assistance through your assigned medical group.

Case managers help you understand your benefits and treatment options so you can make more informed choices. They can also help you navigate through the health care system by working with you, your doctors(s) and a team of other professionals so you can receive referrals, care, services and equipment you need.

Anyone can request CM assistance for a WHA member, including the member. Those who typically qualify are experiencing a catastrophic health situation with complicated treatment plans requiring various specialty services, coordination of care, and pre-approvals to ensure coverage. Examples may include those with new spinal cord or head injuries, cancer, AIDS, or needing organ transplants, but there are many other reasons why you might also be offered this personalized service.

If you or a family member is experiencing a catastrophic health situation and you think you might benefit from CM assistance, please discuss your concerns with your PCP and ask him or her to make a referral on your behalf. Or contact your medical group:

Hill Physicians: (800)445-5747
Mercy/Dignity Health: (916)379-2885
NorthBay: (707)646-4241
UC Davis: (916)734-9900 or (800)445-3936
Woodland: (530)662-3961 ext 4361

For more information contact Member Services at (916)563-2250 and ask to speak with a medical management nurse.