Referrals!!!

PROGRAMS!

100

Where do members find program opportunities to enroll themselves? 

Myuhc.com 

200

Member is overwhelmed with health issues and financial concerns that is affecting medical care. What program would you offer this member?

SODH

300

Member is having hip or knee surgery! What program(s) can you offer?

Specialist management solutions

400

Member is pregnant, what program(s) are available for them? How could you schedule this appt?

 Maternity support program and you would either transfer to T3 nurse or schedule in MHD

500

Member has recently returned home from the hospital and is calling wanting some medical advise due to pain they are having. What can we offer this member, or where should we direct the call?

Can offer to connect them to a T3 nurse to get enrolled in GCM 

Nurse Nurse Nurse!

100

Member missed a call from a nurse, how do we find out who was reaching out to the member and for what program?

ICUE-under history

200

Member has a new diagnosis and needs help understanding medication, treatment or next steps. What program(s) would you offer this member?

GCM--or if specific diagnosis has a eligible program already

300

Caller is advising us they are the caregiver for the member and are needing help with resources. What can you send them?

Caregiver resources ezcomm

400

What programs are you able to schedule in MHD?

CIDM programs. Example: Asthma Management
COPD managment, Coronary artery disease
diabetes management, Heart Failure management, Maternity Support program

CMC (COmplex medical Conditions) can not be scheduled in MHD

500

Member is saying they can not afford therapy for anxiety/depression what can we offer?

EAP Program!!!

Save Money!

100

Member is having upcoming surgery. Medicare is members primary insurance company. What programs can we offer this member?

All applicable programs available EXCEPT Optum Clinical Program

200

How do we know which programs are internal and which programs are external vendors?

Will show Internal for internal and will say UHC Hub Contracted Vendors or External Vendors. (ASK TO SEE EXAMPLE from MEAGAN)

300

Mother calling for 11 year old son. He is having trouble with his asthma and she would like to talk through next steps with someone. Is there a program we can referral son into?

Asthma Management

400

What are our steps when the member calls in and no longer wants to be apart of the program they are enrolled in and does not have a schedule appt for the program yet?

• Access ICUE by navigating to the Eligibility Profile section of the Advocate Dashboard.
• In the Plan Coverage section, select Coverage History. 
• On the Summary tab in ICUE, scroll down to the Program History section.
• Review the Program Owner/Phone Number field to view the nurse's name and phone number. 
• If there is an assigned nurse or coach warm transfer member to nurse and advise that the member needs to speak with them about canceling their program enrollment. 
• If nurse is unavailable offer to connect to nurses VM if declines document and close the call. 

500

Member is interested in the program but does not have time to talk to a nurse today. What would be our next steps?

Schedule appt in MHD for non complex medical condition programs!