A Whole Organization Approach
CareDirector manages the full lifecycle of member cases, from referral through discharge, meeting the individual needs of the person, while providing a framework for consistency, service, responsiveness, efficiency and caring. Configurable assessments can help determine program and eligibility, while workflows and business rules streamline processes and reduce bottlenecks. The consumer portal enables client self-service, empowering members to find approved providers, participate more fully in their own care, and communicate online with their team, resulting in a reduced paperwork and administrative burden.
CareDirector helps Managed Care Organizations to manage their provider network, maintaining a comprehensive record of provider information, including locations, hours, languages, programs, staff, and approved services and rates. With the provider portal, providers may apply online, and (when approved) manage referrals, applications, agency information, view authorizations and record services securely through the portal.
The Resource Search feature helps care managers find approved providers meeting member needs, including Levels of Care, and acuity considerations. The resulting service authorizations tightly link the provider, the care plan and the service; dates, dollars and units. CareDirector supports HIPAA compliant eligibility, claims and reimbursement transactions, facilitating communication with providers, payers, TPAs and state systems.
Features of CareDirector’s Managed Care Organizations Solution include:
- Member Management – Liabilities, Level of care, Medications, Activities of Daily Living, Vital Signs and Metrics
- Staff members- Access into interactive dashboards containing critical information, deadlines, tasks and job specifications
- Integration with State systems – Eligibility and Medicaid
- Financial Staff- Access to a full suite of reports, including capitation and IBNR
- Complex service authorizations – Pharmacy, DME, DMS
- HIPAA Transactions
- Integration with TPAs and Providers
- Portals for Members and Providers – Provide visibility into member, provider and financial management