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  Case Management

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Ultimate Health Plans offers many programs to help members manage their health care needs. Members may be referred to these programs by their physician, an Ultimate Health Plans Care Manager, or a caregiver. Members may also refer themselves for enrollment in these programs. Ultimate also identifies members who could benefit from these programs or services based on diagnoses, care that the member needs but has not yet received, or certain evens such as a recent hospital stay.

Complex Case Management Program

Ultimate Health Plans maintains a Complex Case Management Program for members who may need short-term help after a recent hospital stay or who have more complex needs, such as when dealing with multiple chronic conditions. For example, Case Managers can help members transition home or to a skilled nursing facility after a hospital stay, or work with members who may need extra help with managing multiple medical conditions. Case Managers coordinate with members and the member’s primary care provider and/ or specialists to review medications, create goals for members to manage their own health, provide disease or condition-specific education, and assist with making appointments. Care Managers may also help members address other challenges that prevent them from maintaining their health by arranging for transportation or making referrals for financial assistance.

Disease Management

Ultimate Health Plans offers several Disease Management Programs to help members who have been diagnosed with any of the following conditions:

  • Heart Failure
  • Cardiovascular Disease
  • Diabetes
  • Chronic Lung Disorders

Members enrolled in these programs receive help with managing their conditions. Program services include providing condition-specific education, setting goals and monitoring progress, help making medical appointments, and providing referrals to available community programs and services.

Osteoporosis Management

Ultimate Health Plans maintains a program to help members at risk for developing Osteoporosis or who have been diagnosed with Osteoporosis disease. Case managers may assist eligible members by coordinating DEXA scans, providing educational information, and coordinating with primary care providers for bone-strengthening medications, when appropriate.

Preventive Care and Chronic Condition Management Initiatives

Ultimate Health Plans identifies members who may benefit from certain preventive services, such as flu shots, colonoscopies, and mammograms, as well as other care to help members manage their chronic conditions, such as diabetic eye exams. Ultimate may notify eligible members about care for which the member is due but has not yet received, and help the member get the needed care. Some examples include notifying members about flu shot clinics, help scheduling colonoscopies, arranging for transportation to a facility for a mammogram, or calling or mailing members to remind them that they are overdue for a diabetic eye exam.

Once a member is identified as eligible for a Population Health Program, the member is automatically enrolled but may opt out at any time by calling Ultimate Health Plans. Members may also be disenrolled from a program when they no longer meet program criteria. If you would like additional information about these programs or to request enrollment in a program, please call Customer Service between 8 a.m. to 8 p.m. on Monday through Sunday at 1-855-858-7526 or TTY at 711.

This page was last modified: 1/25/2021 9:52:56 PM

Ultimate Health Plans is an HMO plan with a Medicare contract. Enrollment in Ultimate Health Plans depends on contract renewal. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of each year. Ultimate Health Plans does not collect any member information through this website.


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