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Provider Manual

Programs for Members

Last Updated on May 19, 2021

Health Support for Members

Health Services Department 

Security Health Plan’s Health Services Department is staffed with medical directors, registered nurses, social workers, physical therapists, pharmacists, health educators, assistants and administrative staff who are responsible for the assessment, care coordination and management of the health care needs of our members.

Fair and Consistent Decision-Making    

Security Health Plan strives to make decisions that are reasonable, fair and consistent. Member needs, benefit plans, current medical evidence, national guidelines and stewardship of resources are all taken into account. If a request for medical services is denied based on medical necessity or because it is considered experimental/investigative, providers can discuss the case with Security Health Plan medical directors by calling the Provider Assistance Line at 1-800-548-1224. 

Care Management 

Security Health Plan’s care management services focus on each member’s specific health care needs. The care manager enlists the expertise of our medical directors, registered nurses, engagement associates, social workers, physical therapists, pharmacists and benefit/claims specialists along with providers, community resources and assistance programs to ensure our members receive the needed health care services and supplies according to their benefit plan. Care managers help individuals and families to effectively manage complex situations. 

Care management provides value to members at no added cost by: 
  • Assisting members with complex health care needs such as newly diagnosed, progressive or advanced disease states, traumatic injuries, acute or chronic behavioral health conditions, high-risk pregnancies and ill newborns.
  • Contacting members following hospitalization for a significant health condition to ensure members have the knowledge and assistance needed to recover uneventfully and return to their previous level of functioning. Recommended follow-up is promoted and the risk of readmission is reduced.
  • Outreaching members after discharge from a skilled nursing facility to quickly identify safety concerns, medication issues and/or problems with ADL and home management so that appropriate mitigating actions can be initiated.
  • Promoting preventive care and completion of advance care planning documents.
  • Coordinating referrals, including hospice and home health care services.
  • Addressing caregiver role strain and potential available resources.
  • Supporting safe medication management.
  • Encouraging healthy lifestyle efforts and self-management skills.
  • Assisting members in navigation of the health care system. 

Physicians, other health care professionals, Security Health Plan staff, agents, members or family members may refer members for Care Management services by calling Customer Service at 1-800-472-2363 (TTY 711). Security Health Plan staff also review 24-hour Nurse Line calls, emergency room visits and health-risk assessments to identify members who would benefit from Care Management telephonic services.

Condition Management 

Security Health Plan’s approach to condition management emphasizes disease-specific education that promotes members’ self-management of their condition in partnership with their providers. Security Health Plan provides condition management for members with diabetes, asthma, heart failure, chronic obstructive pulmonary disease and coronary artery disease. Members receive education and telephonic coaching from an RN care manager and are guided toward appropriate self-management. The care manager encourages members to obtain recommended ongoing care and preventive services, recognize and report relevant signs and symptoms, adhere to the prescribed treatment plan (medications, diet, activity) and engage in healthy lifestyle practices. These services are provided to members at no additional charge.

Program features
  • Convenient – We deliver assistance via telephonic, electronic contact and/or mailed information. The care manager works with the member to coordinate an outreach schedule.
  • Comprehensive – We focus on all the ways their condition affects their lives.
  • Collaborative – We promote a collaborative relationship with the member, provider(s), care manager and other professionals.
  • Coaching – We use a motivational approach to promote behavior change for optimal health.
  • Tailored approach – We customize our approach based on an individual’s health needs and goals.
Program goals
  • Improve member health
  • Ensure high-quality health care
  • Change behavior and self-management skills
  • Empower members to effectively manage their condition
  • Prevent health complications
  • Contain health care costs

Online wellness programs

Security Health Plan members have access to online resources including WebMD through My Security Health Plan.
  • Health assessment  – asks basic questions about diet, exercise, sleep, health history and lifestyle. It creates a personalized action plan to help members improve their current health state.
  • Health coaches are available for telephonic support and advice.
  • Daily Habits  –   encourages setting small goals and tracking progress towards improving lifestyle behaviors and chronic conditions. Programs include Lose Weight, Cope with the Blues, Diabetes, Hypertension and many more.
  • Symptom Checker – An interactive symptom checker allows members to explore possible causes of symptoms and identify related treatments. 
  • Health Topics – provides in-depth information about specific health conditions such as depression, chronic fatigue and diabetes.
  • The Wellness at Your Side app is a convenient way to access WebMD programs and information from a smart phone or mobile device.
  • Videos about emerging health trends.
  • Hundreds of healthy recipes with preparation tips and nutritional information.
  • Interactive health-related questionnaires and calculators.
Nicotine-Free program 
Security Health Plan supports members who want to quit using nicotine. We offer full coverage for all FDA-approved tobacco-cessation medications for most members when a provider prescription is obtained. People who get support and education when quitting are more likely to be successful. We offer phone sessions designed to help members develop a plan to quit and discuss the following topics: 
  • Preparing to quit
  • Behavior, habits and addiction
  • Managing stress
  • Living a healthy life
  • Remaining nicotine-free
24-hour Nurse Line   
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. When a member calls, a nurse will: 
  • Listen to health concerns and questions
  • Offer information and medical advice
  • Discuss options for care
  • Provide follow-up as appropriate
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. 

Member advocate 
Security Health Plan’s member advocate is the contact person for members and providers who have questions, problems or grievances with the care received or coverage provided. The member advocate’s goal is to help members overcome barriers and assure members receive high quality, culturally sensitive care.

Nurse navigator 
The nurse navigators at Security Health Plan work to ensure members receive the care they need within their benefit plan. They research questions and coordinate care related to medical conditions and provide information on benefits and insurance coverage.

If needed treatment is not available in network, they identify options for needed care outside the network and assist with preauthorization for needed care in and out of network. Nurse navigators work with members, care managers, providers and others at Security Health Plan to ensure members’ health needs are met.

Contact information

Behavioral health/social workers

Care management 

Condition management 

Medical directors 

Member advocate

24-Hour Nurse Line

Nurse navigator 

Quality management 

Utilization management