Patient-Centered care coordination
CCNC Care Management is an award-winning, patient-centered case management model with a proven return on investment in North Carolina.
Our Care Management Teams work locally with patients and providers to coordinate medical, behavioral, and social needs.
We use an evidenced-based Standardized Plan to provide Assessment, Patient-Centered Care Plans, Goal-Setting and Medication Management, as well as advanced analytics to target patients who could most benefit from care management services.
Our Interdisciplinary Care Management Teams Include:
- Registered Nurses
- Social Workers
- Certified Care Managers
- Care Manager Support Staff and Community Health Workers
- Pharmacists and Pharmacy Assistants
- Behavioral Health Consultants
- Palliative Care Consultants
Care Managers Help Patients by:
- Providing education related to medications and diseases
- Assisting patients in setting goals and preparing for behavior change
- Supporting patients to reach self-management
- Teaching appropriate use of the hospital Emergency Department
- Reinforcing preventive care
- Transitioning high-risk patients from the hospital to home
- Improving communication with and among multiple providers
- Connecting patients to community resources, social services, and behavioral health options
Who is Eligible for Care Management?
- Carolina Access II Medicaid patients who meet various “Priority” indicators including hospitalizations
- Carolina Access II Medicaid patients referred by providers and hospital staff
- Medicare, Uninsured, and private insurance patients depending on specific program guidelines
for more information or to Make a referral:
Call 828-348-2290 | Fax referral form to 828-348-2298
Adult & Pediatric rEFERRAL FORM PREGNANCY REFERRAL FORM