Medical Management

Putting members first
when they need it most.

That’s why we’re here.

Healthcare can feel complicated, confusing, and even a little scary. That’s why our Medical Management team takes our members by the hand to ensure they understand their options and receive the care they deserve. It’s meaningful work from a uniquely talented team.

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See this very moving story of one member’s life-changing experience with our Care Advocacy team.

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Check out this short roundtable discussion with our team to learn how and why they do their important work.

“I’m speechless and almost in disbelief. This is incredible, we are over the moon grateful for all you’ve done. Thank you, thank you, thank you!!!

HealthEZ member

Going beyond traditional care management

Better outcomes, timely assistance, caring guidance and even a helpful nudge. It’s all part of the concierge services available to our members.

  • Care Advocacy


    We are the go-to contact for our members, no matter where they are on their health journey.
    From finding a primary care doctor to making post­op appointments, we are there in moments
    of need.

    • Single point of contact
    • Preferred provider referrals
    • 24/7/365 help line
    • Coordination of services
    • Our 71%-member engagement rate is more than 2x the industry average
  • Utilization and Case Management


    We provide resources, education, and a review of members’ cases when there is a chronic or
    complex condition requiring case or disease management. Our team goes the extra mile for
    each member.

    • Utilization review completed by highly trained nurses and physicians
    • Provide education and resources
    • Medical necessity reviews
    • Precertification needs
  • Trigger Reporting


    Even if members don’t know to reach out, we ensure that no one is left behind. All utilization
    review, treatment requiring precertification, high dollar drugs, 50% specific deductible, and ER
    visits trigger an internal review process to assess potential risk, member need and cost
    implications.

    • Early identification of potential large claims
    • Review for alternative care options
    • Early identification of steerage opportunities
    • Member contact with each Emergency Room visit

Care management programs

Whether it’s a chronic illness or a new pregnancy, we’re here to help members navigate through their healthcare journey. Our member engagement rates lead to better outcomes and reduced risk and costs.

Chronic Care
Management

We help members manage chronic conditions like diabetes, hypertension, and high cholesterol by providing education, diet, and exercise tips. We can even provide referrals to providers and order medical supplies for our members.

HealthEZ’s team of health care professionals believe that partnership and realistic support are the keys to lasting change.

HealthEZ works with a program called Livongo which helps members stay on top of their health.

Through this partnership, HealthEZ members can get connected devices, personalized guidance, on-demand coaching, an easy-to-use app, and more for help managing:

  • Pre-diabetes
  • Diabetes
  • Hypertension

Boost Your
Baby Program

HealthEZ offers maternity support by providing education and resources to promote a healthy pregnancy through post-partum. Expectant parents receive:

Dedicated single point of contact throughout the pregnancy journey

Referrals to internal programs for additional support

Tips to stay happy and healthy during and up to six months after pregnancy

LEARN MORE

Our members’
health is what drives us.

At HealthEZ, we believe nothing is more important than the health of
our members. Our Medical Management team is driven to make a
positive difference in their lives.