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Provider Manual

Transition Care Management

Last Updated on January 24, 2019

In order to ensure continuity and coordination of care between treating acute care facility providers and PCPs, Security Health Plan developed a member-centered program to facilitate the transition from hospital to home.  Our program provides transitional care to members for up to 30 days who are discharged from a hospital inpatient setting and skilled nursing facilities.  Discharge must be from a participating hospital and inclusion criteria must be met.   The Transition Care program goal is to avoid re-hospitalization. 

Other Care Management services available for our members are

  • 24-hour Nurse Line (1-800-549-3174).  Security Health Plan has a phone line, staffed by registered nurses, available to members 24 hours a day, 7 days a week. The nurses servicing the phone line are specially trained in triage and are ready to discuss health-related questions and concerns.  The nurses use guidelines approved by physicians to advise members as to what type of care they may need: self-care, physician appointment, urgent care or emergency care. The nurses offer advice. The final decision regarding type of care is always the choice of the member.
  • Nurse navigator.  A nurse navigator is a registered nurse, supported by medical directors, who works across the health care system to help members receive the right care at the right time. A nurse navigator can assist members in managing their health care resources and act proactively on their behalf. The goal is to enhance the quality of care members receive by helping them navigate through a complex health care system.
  • Member advocate.  Security Health Plan has an advocate on staff to assist members. The advocate is the member’s contact in the event of a formal grievance, but is primarily available to help answer questions and solve problems that may prevent a grievance from becoming necessary. It is the advocate’s job to assure member access to care and quality of care, and to help the member overcome barriers he or she might encounter within Security Health Plan or the provider network. The advocate is responsible for ensuring members receive culturally sensitive care. The advocate is available to any Security Health Plan member. Providers may call the advocate for assistance with any Security Health Plan members.