MRC Medicaid Plan Solutions

MRC provides nurse case management consulting and social worker services to assist Medicaid health plans in caring for their member population. We deliver person-centered medical case management regardless of the member’s social determinants of health. One of our long-term objectives when possible is to have members become contributing members of their local community.  When we improve access to care and support the health goals of the member community, the quality of life for the member increases as a result.

As an example, many times the low and moderate-risk Medicaid members can very quickly and easily move into the high-risk, high-dollar, and catastrophic category. The MRC Nurse Consultants are trained to recognize these members as soon as they are identified by the plan administrator or claims adjudicator. The MRC Nurse Consultants work to build a trusting relationship and rapport with the member and/or their family member.

MRC encourages appropriate use of medical care resources while educating about inappropriate use (reversing the trend of ER visits). MRC attempts to direct the appropriate level of care such as home care rather than inpatient stays/long-term care, urgent care rather than emergency rooms, and timely primary care visits rather than no visits).

MRC educates the member and family members to prevent injury/re-injury, hospitalization/re-hospitalization, and this results in reversing trends of non-compliance and fosters independence.

For very high-risk, catastrophic, or high dollar cases, intensive case management is provided ensuring the highest possible quality care to the member.