Population Care Management

SoonerCare Population Care Management (PCM) is comprised of three distinct work units: Case Management, the Health Management Program (HMP) and the Chronic Care Unit (CCU). Together these units coordinate and facilitate the delivery of health care to our members through the most appropriate resources, providers and facilities within the scope of the SoonerCare program.

The enhanced benefits of PCM offer patient and provider more ways to help control complex conditions and improve quality of life. PCM is provided at no cost to our SoonerCare members or providers.

Case Management Unit

SoonerCare Case Management works with members identified through various programs or those who are in need of episodic or event-based health care (e.g. breast and cervical cancer patients or members with special needs). This includes a variety of obstetrical and pediatric services, as well as out-of-state care coordination, long-term care waivers reviews and complex case management.

  OB Case Management includes:

 ·         At-Risk Obstetrical Case Management

 ·         High-Risk Obstetrical Case Management

  Pediatric Case Management includes:

 ·         At-Risk Newborn Case Management

 ·         Infant Mortality Reduction Case Management (targets specific high-risk counties)

 ·         Private Duty Nursing Case Management

 Other Services:

 ·         Oklahoma Cares Program

 ·         Out-of-State Care Coordination

 ·         Complex Case Management

 ·         ER Utilization Case Management

 ·         Long-term Care Waiver Clinical Reviews

 ·         Social Service Coordination

Health Management Program

The SoonerCare HMP provides practice-based, chronic disease-focused supports to Sooner Care Choice members and their primary care providers. Nurses, known as Health Coaches, work with members at their medical homes and over the phone to improve health outcomes. Specially-trained practice facilitators also work with these selected practices to improve processes related to caring for persons with chronic illness. 

Learn more about the SoonerCare HMP

Chronic Care Unit

In the CCU, nurses provide telephonic case management to high-risk and at-risk members with chronic conditions - members whose PCP is not aligned with an in-office health coach. CCU works to assess and address the health status, health literacy, behavioral health and prescription drug utilization of our members through care coordination, self-management principles and behavior modification techniques.

Care for chronic conditions includes, but is not limited to, management of: diabetes, hypertension, cardiac disease, asthma, hemophilia, sickle cell anemia and hepatitis C.

Contact Us

Health care providers, family members and other care coordinators may request PCM services for beneficiaries 8 a.m. - 5 p.m. weekdays by calling 405-522-7650 (Oklahoma City area) or 877-252-6002 (toll-free). Services may also be requested by filling out our online Care Management Referral form.