Focused on members

Our care coordination approach supports a member’s health and human service needs. Our care coordinators are trained to look at the whole person. Empathy and trust are central to success. Care coordination is built around advocacy, communication and providing resources.

Care coordinators

Our care coordinators work with members to connect and engage with primary care and the health care system. Care coordinators:

• Support the member to achieve their health goals.
• Link members to health and community services.
• Help members take an active role in their care.
• Work to improve overall member well-being.

Our care coordinators are nurses or social workers.

Care coordination for SNBC members

All SNBC members have access to care coordination. Care coordinators assist our members to connect with social and health care services. Care coordinators help members complete a health risk assessment to better understand a member’s situation and needs. This helps ensure that our members with disabilities have an equal ability to access the resources they need. The care coordinator meets with the member to develop an individualized care plan to help maintain optimum health and well-being.

Our goal is to provide the right care at the right time and place. We place a major emphasis on meeting members where they are. This includes respecting and acknowledging their cultural context. We focus on health education, helping members choose their care, and involvement of family caregivers and community. 

Care coordination for PMAP/MinnesotaCare members

Some members may benefit from care coordination based upon their special health care needs. Care coordination may be available for members who experience all of the following:

• They have more than two chronic health conditions.
• They have trouble meeting basic needs like food and clothing.
• They do not have care assistance from another county worker, clinic coordinator or case manager.

Contact Member Services to learn more. 

Care coordination referral by providers 

Providers can refer a PMAP or MNCare member for care coordination through the Epic® system or the online care management referral form, or by calling Member Services.