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Care Management

We understand some members have special or complex medical needs. Sunshine Health offers our members care management services to help with special healthcare needs. If you have special needs or a disability, care management may be able to help you. Our care managers are registered nurses or social workers. They can help you understand major health problems. They can also arrange care with your doctors. A care manager will work with you and your doctor to help you get the care you need. Care managers can talk to your doctors, help with scheduling appointments and coordinate your care.

This service is for members who may need more help taking care of their health. These members often have several medical conditions, see several doctors, have a new diagnosis that they need help to manage, or need help arranging many services the doctor has ordered. Our care managers can help members understand their health problems and work with their doctors to help get the care they need. If you think that care management may be able to help you, call Member Services at 1-866-796-0530 for more information. You can ask to speak to a care manager.

Sunshine Health’s care managers also can connect members to services and resources available from community agencies. They help identify available resources and refer members to those agencies for help. This can include resources like food banks, WIC or housing support. Some of our care managers do home assessments to identify health risks or safety issues in a member’s home related to issues like fall prevention. Care managers also educate members and their families on the value of an Advance Directive, how to obtain one and with whom they may consider sharing their Advance Directive.

Private Duty Nursing (PDN) Real-Time Reporting Process

We want to ensure that your child is receiving the services required to keep them safe in your home. Please contact Sunshine Health right away when a Private Duty Nursing shift is missed. Here are a couple ways to reach us:

  1. Contact your child’s Care Manager
    If you don’t know who your child’s care manager is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  2. Contact your child’s Care Manager’s supervisor
    If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  3. Call the 24-hour Sunshine Health Nurse Advice Line
    1-866-796-0530 (TTY 1-800-955-8770)
    • Press 1 for Member
    • Press 2 for LTC or 3 for MMA
    • Press 5 for Nurse Advice Line
  4. Email Sunshine Health
    PDN_Escalation@SunshineHealth.com
    • Include your child’s name, Medicaid ID number and home health provider, the date and time of the shift missed, and your contact information.

When we are notified of a missed shift, your child’s Care Manager will:

  • Contact your child’s home health agency to identify the issue with coverage.
  • Work with the home health agency to ensure services will occur as authorized.
  • Help with finding another home health agency who can provide care to your child.  

Please contact your child’s Care Manager if you have any questions or concerns.

Frequently Asked Questions

The care management team includes nurses and social workers. They can help you learn how to take care of yourself. They can also help you get services. They will work with your doctor.

Care management is for people with long-term or complicated illnesses. It can help you stay healthy if you have a chronic condition such as cancer, high blood pressure or diabetes.

Care management is not required. If you are interested you or your doctor may ask for care management. Call 1-866-796-0530.