Case Management Department

The Case Management Department can work with members who need help managing their healthcare and social needs that impact their overall health. Our goal is to promote good health by assisting you in the care you need by connecting to the appropriate service and resource available.  Case Management Department consists of nurses, social workers, and support staff who works together with you, your family, your primary care provider, and other people in your care team. 

Case Management is a free benefit for Contra Costa Health Plan members. These programs are voluntary, and members may opt out at any time. The following programs are available for members:

Care Coordination

Care Coordination Program provides services to members who needs assistance navigating healthcare and accessing services and focuses on building natural support networks that improve independence and wellness allowing for eventual program discharge.

Who is Eligible?

Any CCHP Members who require assistance and support with:

• Navigation of the health care system, including, but not limited to, making appointments and reminders, finding needed service providers.
• Coordination of health care services and social services affecting health.
• Connection to available community resources that impacts their health, including public benefit programs.
• Referrals to appropriate services and support programs.  

Transitional Care Services (TCS)

Transitional Care Services provides services to members who are transitioning from one setting or level of care to another, including, but not limited to: discharges from hospitals, institutions, other acute care facilities, and skilled nursing facilities (SNFs) to home or community-based settings, Community Support placements, post-acute care facilities, or long-term care (LTC) settings. 

Who is Eligible?

Any CCHP Member who has had a transition from one setting or level of care to another as outlined above. 

Typical interventions include:

• Discharge plan review

• Medication reconciliation

• Coordination and follow up of services as outlined in the discharge summary

• Coordination with discharging facilities to support discharge plans and help address any barriers to discharge, if any

• Collaboration with other members of your care team

• Screening and referral to appropriate ongoing case management program

Who is Eligible?

CCHP Members who require intensive support and assistance with managing complex health conditions and requires extensive use of resources as manifested by increased hospitalization and emergency room visits.  Members who are not eligible or decline to participate in Enhanced Care Management (ECM) are considered for Complex Case Management. Members enrolled in Enhanced Case Management (ECM) are not eligible to concurrently receive Complex Case Management (CCM).   

Typical interventions include:

• Comprehensive assessment of needs and condition, available benefits, and resources
• Development and implementation of an individualized, and member-centric care plans.
• Navigation of the health care system, including, but not limited to, making appointments and reminders, finding needed service providers.
• Coordination of health care services and social services affecting health.
• Connection to available community resources that impacts their health, including public benefit programs.
• Referrals to appropriate services and support programs.
• Transitional Care Services (if already enrolled in CCM)

How to Request for Case Management Services:

Requesting a referral from your doctor

Calling CCHP Case Management at 925-313-6887 (TTY 711) and requesting case management services.  Interpretation or translation services are free and available.  

Complex Case Management (CCM)

Complex Case Management (CCM) Program provides services to members who need extra support to avoid adverse outcomes but are not eligible or decline participation in Enhanced Care Management (ECM). CCM provides ongoing chronic care coordination and interventions for episodic, temporary needs with a goal of regaining optimum health or improved functional capability in the right setting and in a cost-effective manner.

Who is Eligible?

CCHP Members who require intensive support and assistance with managing complex health conditions and requires extensive use of resources as manifested by increased hospitalization and emergency room visits.  Members who are not eligible or decline to participate in Enhanced Care Management (ECM) are considered for Complex Case Management. Members enrolled in Enhanced Case Management (ECM) are not eligible to concurrently receive Complex Case Management (CCM).