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Care Manager Q & A: Looking Out for You

As your health plan, we have programs to help you if you get sick or injured. Carolyn has been a Care Manager for over 10 years and is a team leader in our care management program. We asked her to talk about the program and what she likes most about what she does. Take a look!

What is a care manager?

A Care Manager is a nurse or licensed therapist who helps guide members with unexpected health issues through the healthcare system.

Who has a care manager?

Not everyone needs a Care Manager but we are here if you need us. We are available to all Tufts Medicare Preferred HMO members, but generally members who need extra help, have been in the hospital, have a chronic condition (such as diabetes), or are frequently sick or injured are more likely to work closely with a Care Manager.

What does a care manager do?

We have many roles, but our focus is always on the member and what is best for them. We help members develop skills that will make it easier for them to get the type of care they want. For example:

  • Preparing for doctor visits: When our members go to the doctor we want them to understand that it’s their appointment.We help members prepare questions to ask their doctor so they don’t feel rushed through an appointment. It’s important to understand your doctor’s instructions and get what you want from the appointment. Helping our members talk to their doctor is a big part of a Care Manager’s role.
  • Creating an action plan: An action plan is how a member intends to get healthy after an illness or procedure and stay healthy once they are feeling better. We help members create a plan that works for them. For example, some members might want to see if there is an alternative to the medication they have been prescribed, or may prefer to receive care at home instead of a hospital. We don’t push our wishes on them, but instead advocate for what they want.
  • Finding the root of the problem: We help to identify the source of a health issue that may have been overlooked. Recently, I was notified of a member who had several emergency room visits in a short time because she fell multiple times. I visited the member in her home and noticed she kept her teacups in the top cupboard and had to lean over a chair to reach them. She had always kept them there and never had a problem before but the location of the teacups was the cause of her falls. A solution as simple as moving the teacups to a lower shelf helped to prevent her from falling.
  • Improving communication: Care Managers help members express their health goals to their doctors in a way that gets results. Healthcare is a complex system, and helping members communicate with the different areas is important so they get the care that is right for them.

What do you like most about being a care manager?

Doing everything possible to help a member get the solution that is most beneficial and comfortable for them. I get a lot of satisfaction from helping our members through an unexpected illness or injury.

What is the most challenging part of being a care manager?

Care Managers have to be knowledgeable in many different areas of the healthcare system. Helping members with a wellness plan, talking to doctors and families, it’s a lot of hard work and a tremendous challenge, but I wouldn’t want to do anything else.

What's the most important thing for members to know about the care management program?

We are part of the member’s health team and want what’s best for them. Our goal is to help our members be healthy, safe, and ready to move ahead. Tufts Health Plan Medicare Preferred is much different because our focus is on our members. It makes me happy to work here. We are passionate about our member’s health and their experience with the healthcare system.

Wellness Coordinators: Part of Your Care Management Team

Care Managers and Wellness Coordinators are part of the same team. A Wellness Coordinator is specially trained to help guide members after a hospitalization. They stay in contact with the member for 30 days after leaving the hospital to make sure the member is okay, and has what they need. A Wellness Coordinator makes sure the member isn’t having pain, can get to their appointments, and has the prescriptions they need. They can refer members to a Care Manager if the member needs more assistance. Together Care Managers and Wellness Coordinators work as a team to look out for our member’s well-being.

For more information

To learn more about our Care Management program, call Customer Relations at 1-800-701-9000 (TTY: 711).