Virginia Premier Health Plan, Inc.

Case Management Services

VPHP offers an intensive Case Management Program for all members that are high risk and who require complex medical interventions. The Case Management Team works closely with the member's PCP to coordinate healthcare services across the continuum of care. Case Managers may also intervene when patients that demonstrate non-adherence to their treatment plan. Circumstances that warrant referral to the Case Management Team include:

• Presence of progressive, chronic, or life-threatening illness
• Need for inpatient or outpatient rehabilitation
• Terminal illness
• High risk pregnancies
• Acute/traumatic injury, or an acute exacerbation of a chronic illness
• Complex social factors
• Children with Special Health Care Needs
• Multiple hospitalizations or emergency room visits

The case management program includes the following services:

• Support of the PCP’s treatment plan
• Coordination of services
• Education on disease/illness and benefits
• Referral to community resources

To refer a patient for VPHP's Case Management Services, call Medical Management at 800-727-7536 in the Central Virginia Area, 800-828-7989 in the Tidewater Area, and 888-338-4579 in the Roanoke Area.  Or, utilize our Online Care Management Request Form.