Care Management

Live your healthiest life with programs and services at no additional cost to you.

Paving the way to wellness and self-management

Get support to live healthier. Find out which programs and services are included with your plan so you can get the help you need.

Connect with our Care Management team for support. Call us at 702-797-2100 or toll-free 1-877-487-6659, TTY 711.

Need a little help managing life’s demands? Our medical management social workers are ready to assist you.

Medical management social workers can help with:

  • Information on community resources
  • Financial, housing and transportation needs
  • Care coordination with the health care system
  • Advanced directive education

This program is available to members of all ages.

Getting you to the right care. Our Care for Me Program nurse serves as your single point-of-contact. The nurse will work with you, your primary care provider (PCP), caregiver and other health care professionals to help manage your health care needs.

Some of the program services include:

  • Access to a registered nurse
  • Care coordination
  • Help with needs after a hospitalization, emergency room or urgent care visit
  • Follow‑up appointments and phone calls
  • Specialist and procedure appointments
  • Self-care advice and management
  • Medication review
  • Health education
  • Referral and prior authorization assistance
  • Resource for all social and insurance issues
  • Transitions to other health care programs or services

A personal health care assistant. Just for you. Your assigned CHW will serve as a liaison between you and your health plan to help you make the most of the benefits and resources available to you.

Your CHW can help you:

  • Select or change your primary care provider
  • Organize medical needs and specialist appointments
  • Get the information and resources you need to manage diabetes asthma, and nutrition (for the whole family)
  • Arrange transportation for your follow-up appointments
  • Get a referral to a licensed social worker and complex case management as needed

Simplifying your health care journey. Our case managers are registered nurses (RN).

They work closely with you and specialty providers to find solutions to your specific health care needs for conditions like:

  • Congestive heart failure
  • Hypertension
  • Heart disease
  • Diabetes
  • Chronic obstructive pulmonary disease (COPD)
  • Asthma
  • HIV
  • Other complex conditions such as cystic fibrosis, cerebral palsy and sickle cell anemia

This program is available to adult members age 18+ with complex health needs.

Improving health and well-being with patient-centered care. Whole person care is the coordination of medical, mental health and social services through a patient-centered approach. This program is for adults age 18+ with complex medical and mental health needs.

Caring for medically fragile children. It’s our goal to enhance the quality of life for our youngest members and to minimize disability and illness.

Our team of highly skilled nurses provide quality care, tailored to the child’s unique medical needs, including:

  • Complex medical conditions
  • Special health care needs
  • Autism

This program is for members age 18 and under with high-risk needs.

Managing high-risk pregnancies and preparing for childbirth. Our case managers are registered nurses. They work closely with you and your doctor to help lower the risk of complications during pregnancy and delivery. If you have any pregnancy benefit questions, please call 1-844-851-7830, TTY 711.

Feel better and live happier. Our compassionate team of licensed complex case managers provide support to members with mental health and substance use issues.

They can help with things like:

  • Substance use treatment including women who are pregnant who need substance use care
  • Depression
  • Severe mental Illness
  • Severe emotional disturbances

This program is for members of all ages. To find out more, call 702-364-1484 or toll-free 1-800-873-2246, TTY 711.

Find hope and strength through peer support. Connect with a peer who has been through a similar mental health or substance use experience, and is now in long-term recovery. For more information, call 702-364-1484 or toll-free 1-800-873-2246, TTY 711.

Providing care and comfort at the end of life. Supportive care is for members 18 and older with life-threatening or terminal illnesses, such as cancer or kidney failure. This program includes pain and symptom management, assistance with decision-making and end-of-life care.

Health care advice. Just a phone call away. If you’re unsure about your condition, our 24/7 advice nurse may be able to help. Our nurse is available to answer questions, provide self-care advice and help you decide whether to seek urgent care, emergency care, or schedule an appointment with your provider. Call toll-free 1-800-288-2264, TTY 711.

Your health. Your way. Attend weekly livestream classes, watch on-demand health education videos and/or schedule a phone consultation with one of our health educators at no additional cost to you. To speak with a certified educator or registered dietitian, please call 702-877-5356 or toll-free 1-800-720-7253, Monday through Friday, 8 a.m. to 5 p.m.

Take control of your health with the help of a registered nurse. Get personalized support to self-manage your prediabetes, diabetes, asthma or stage 3 chronic kidney disease (CKD). To join, please call 702-242-7346 or toll-free 1-877-692-2059, Monday through Friday, 8 a.m. to 5 p.m.

Get equipment to help you complete daily activities. If you’re in need of medical equipment like diabetic supplies, blood pressure monitors, ostomy supplies or breast pumps, call Southwest Medical Pharmacy and Home Medical Equipment at 702-796-1016. Northern Nevada members call 1-800-962-8074, TTY 711.

Understand your pharmacy benefits. preferred drug list (PDL) is a list of drugs covered under your health plan.

If the medicine your doctor is prescribing is not on the preferred drug list, Health Plan of Nevada may not pay for it or the medicine might require prior approval. If it does, your doctor may call our Pharmacy Services team or send them a prior authorization fax.