Utilization Management and Case Management Programs

What Services Are Provided?

Utilization Management: Services requiring prior authorization are detailed in Mississippi's State and School Employees' Health Insurance Plan’s Benefit Plan Document. Nurses, physicians, and administrative staff are available to answer questions and assist both participants and providers with the prior authorization process. Staff is also available to assist participants in locating network providers. Online Provider Search is also available at any time for both the AHS In-State Network, as well as the Blue Card Out of State Network, located here:

Preadmission Education and Discharge Planning: This service is available to participants who have scheduled elective procedures. Registered nurses educate participants (and family members) on the procedure to be performed and what to expect before, during, and after the procedure. Nurses coordinate with servicing providers to identify, then coordinate support that will be needed after discharge such as medical equipment, medications, home care/therapy, and follow-up appointments. Initiating discharge planning before admission ensures participants can go home once their medical condition has stabilized.

Post Discharge Support: The same registered nurse who collaborated with the participant prior to admission is responsible for supporting the participant (and family) post-discharge. This nurse is available to answer any questions and assist the participant (and family) in following their prescribed discharge plan.

Case Management: This is a voluntary program designed to provide participants the information and support they need to realize their health goals. A registered nurse case manager works in collaboration with physician(s) to help participants understand and follow the treatment plan that was ordered by their physician.