Complex care management is a free benefit available to qualifying Vaya members who receive Medicaid or are uninsured. Formerly called care coordination, complex care management is designed to help people with mental health needs, substance use disorders or intellectual or developmental disabilities (IDD) who may also need special medical and social support. Our team-based approach to healthcare and integrated treatment planning make it easier to connect with the care you need.
Through complex care management, you will be matched with a care manager (formerly called a care coordinator) who will get to know you and your needs. Your care manager will work with you, your loved ones, your doctor and your other healthcare providers to connect you to appropriate support and services. Care managers work to:
- Identify members who are eligible for complex care management through referrals and reports
- Complete a health risk assessment to identify areas where you may need support
- Develop a care plan with prioritized, whole-person goals and interventions
- Manage your services across the continuum of care and link you to appropriate treatment
- Ensure you receive appropriate clinical assessments and evaluations and have access to clinical and medical specialists
- Assist members who are at high risk for hospitalization or institutionalization
- Support members returning to the community who have been living in an institution, hospital or residential setting
- Check on the health and safety of N.C. Innovations participants
How can I make a complex care management referral?
We accept internal and external referrals for complex care management from any organization or individual (including members, caregivers, hospital discharge planners, the N.C. Division of Juvenile Justice, departments of Social Services, primary care and behavioral healthcare providers, disease management programs, utilization management programs, health information lines, etc.) using the Vaya Health Complex Care Management (Coordination) Referral Form.
For more information, call Vaya Member Services at 1-800-849-6127.
What is the Geriatric and Adult Mental Health Specialty Team?
Complex care management includes education and support opportunities through the Geriatric and Adult Mental Health Specialty Team. The team serves professional staff, family caregivers and other individuals who care for or work with older adults experiencing dementia or other behavioral health concerns.
To make a referral to the team, please complete the Geriatric and Adult Mental Health Specialty Team Referral Form. For information on the team’s upcoming education opportunities, visit our Calendar of Events.