Case Management

Members of Western Health Advantage (WHA) may receive personal assistance with referrals and getting the care they need through Case Management (CM) program services. If a member qualifies, usually because of complex healthcare needs, individual assistance is provided by an experienced case management nurse available through the member's assigned IPA or medical group.

Case managers help members understand health plan benefits and treatment options so they can make more informed choices. They also help members navigate through the health care system by working with their doctors(s) and other health care professionals to receive appropriate referrals, medical care, and other services and equipment when needed.

Anyone may request CM assistance for a WHA member, including the member or his/her doctor. Those who typically qualify are experiencing a catastrophic health situation with complicated treatment plans requiring various specialty services, coordination of care, and prior authorizations to ensure coverage. Examples may include patients with new spinal cord or head injuries, those with a new diagnosis or recurrence of cancer requiring active treatment interventions, or diagnosed with AIDS, but there are many other reasons why a member might qualify for CM services.

If a WHA member is experiencing a catastrophic health situation and you think s/he might benefit from CM assistance, please send an electronic referral or request assistance by calling the Medical Management department of the member's contracted IPA or medical group:

Hill Physicians: (800)445-5747

Mercy: (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 regarding this topic, you may also call WHA's Member Services department at (916) 563-2250 or toll-free at (888) 563-2250 and ask to speak with a Medical Management nurse.