Complex Case Management

Sanford Health Plan’s Complex Case Management Program is available to qualifying Health Plan Members and their families "FREE" of charge. Complex case management is a process that aims to identify high-risk or high cost Members, assess treatment options and opportunities to coordinate care, design treatment programs to improve quality and efficacy of care, control costs and manage Member care to ensure the optimum outcome. Concentrating for the most part on catastrophic or chronic cases, case manager nurses are called in to consult and manage diagnoses such as serious traumas, cancers, organ transplants, spinal cord injuries, multiple chronic illnesses and/or chronic illnesses that result in high utilization.

A designated case manager, who is a registered nurse, is responsible for managing these complex cases to ensure high quality, cost effective and appropriate utilization of health services. The case manager acts as a Member advocate, seeking and coordinating creative solutions to a Member’s health care needs without compromising quality health outcomes for selected medical diagnoses. The case manager contacts our Members by phone and mail. She is able to act as a resource, educator and/or coordinator of all medical care if needed.

If you would like more information about this program and whether your Sanford Health Plan patient meets the criteria to participate in the program, please contact our Complex Case Manager at 1-800-805-7938 or 605-328-6800 or um@sanfordhealth.org.