While case managers work directly with the member to assist them with their medical and other identified needs, they also work hand in hand with both the third party administrator and stop loss carrier to keep them informed as to the member’s condition and any potential stop loss concerns that may result.

MCC utilizes trigger diagnosis to initiate case management or case management may be requested by the TPA/Employer Group. In addition to the standard trigger diagnosis listing, Managed Care Concepts also identifies members for case management services by a number of other triggers, such as members in the hospital greater than five days, members with multiple authorizations in a short time period and members who have reached 50% of spec. 

In addition to its catastrophic and short-term case management offerings, Managed Care Concepts also has several specialized case management programs, such as its maternity, hip and knee replacement programs. Managed Care Concepts also has a robust transplant case management offering as well.