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Molina Healthcare provides a comprehensive Care Management (CM) program to all Members who meet the criteria for services. The CM program focuses on procuring and coordinating the care, services, and resources needed by Members with complex issues through a continuum of care. Molina Healthcare adheres to Case Management Society of America Standards of Practice Guidelines in its execution of the program.

The Molina Healthcare care managers are licensed professionals and are educated, trained and experienced in the- Care Management process. The CM program is based on a member advocacy philosophy, designed and administered to assure the member value-added coordination of health care and services, to increase continuity and efficiency, and to produce optimal outcomes. The CM program is individualized to accommodate a member’s needs with collaboration and approval from the member’s Primary Care Physician (PCP). The Molina care manager will arrange individual services for members whose needs include ongoing medical care, home health care, rehabilitation services, and preventive services. The Molina care manager is responsible for assessing the member’s appropriateness for the CM program and for notifying the PCP of the evaluation results, as well as making a recommendation for a treatment plan.

Members with the following conditions may qualify and should be referred to our Case Management Department:

• Hospitalizations (Primary Diagnoses): Psychiatric, substance abuse, admissions for controllable diseases
• Foster Care
• Social issues: Medical neglect, Serious SDOH challenges
• Life Threatening Chronic Diseases: HIV/AIDS, Cancer, Tuberculosis
• Members with three or more consecutive missed appointments
• Significant impairments: hearing, vision, mobility, cognitive/mental impairments
• Pregnant members
• Members that failed to meet health prevention guidelines
• Newly diagnosed members: asthma, diabetes, HIV/AID, mental illness, substance abuse, failure to thrive, low birth weight, critically ill newborn, newborns with NICU stay greater than 24 hours
• High-risk populations that would benefit from Case Management Services
• Other members that will benefit from Care Management services, all Mississippi member are eligible for Care Management Services. 

Referrals to the CM program may be made by contacting Molina at:
Phone: (844) 826-4335
Fax: (844) 206-0435

Members that qualify for the Care Management Program are referred to care management based on assessment of their need and Risk Category.

Risk Category

Each member identified as being at risk is evaluated through our risk stratification process of assessing members to determine the appropriate level of intervention needed. Members are grouped based on factors such as age, medical history, current health status and specific health conditions. Molina Healthcare of Mississippi use four levels of intervention to identify Risk Categories: Health Management, CM, Complex CM, or Intensive Needs. 

LEVEL 1 – Health Management (HM)

The Health Management Program is focused on disease prevention education, health promotion and member self-management.  It is provided for members whose lower acuity chronic conditions, behavior (e.g., smoking or missing preventive services), or unmet needs (e.g., transportation assistance) put them at increased risk for future health problems and compromise their independent living.

LEVEL 2 – Care Management (CM)

The Care Management Program (CM) is provided for members who are at risk for re-hospitalization or with CM needs that may require more support than Level 1 HM and further assessment of their needs.  CM is designed to improve the member’s health status and reduce the burden of disease through education and assistance with the coordination of care to collaboratively assess the member health needs, create Individualized Care Plans with prioritized goals, and facilitate services that minimize barriers to care.

LEVEL 3 – Complex Care Management (CCM)

The Complex Care Management Program (CCM) is provided for members who have experienced a critical event or diagnosis that requires extensive use of resources and additional support navigating the health care system.  

LEVEL 4 – Intensive Needs 

The Intensive Needs Program is provided for members with a need for stabilization and/or end-stage diagnoses. Interventions are designed to stabilize a member’s health status, improve their ability to cope with the severity of their conditions, and improve their quality of life. Care Managers monitor, follow-up and evaluate the effectiveness of the services provided on an ongoing basis.

Molina Healthcare Mississippi is here to support your healthcare needs. Completing a Health Risk Assessment (HRA) will allow us to better understand your unique needs so we can connect you with additional supports and services you might need. 

Members can contact the Care Management Department at 844.809.8438 (TTY/TDD: 711) to complete a Health Risk Assessment and to receive more information about Risk Categories.