Problem Identification

The primary role of case managers in the Disease and Case Management department at ABC Health Insurance
Company is to provide disease management and coordination of care to members. The company is shifting
health plan networks and given the directive that case managers are now expected to provide basic information
about benefits to members. Historically, case managers have been directed to transfer members to a member
services representative related to benefit information. Since this is a change in policy and job duties, current
case managers have never been trained on accessing benefits in the database, understanding them, or how to
communicate them to members. The Benefits 101 training outlined here was developed to respond to the
companys new directive with the goal of preparing case managers to be able to provide basic benefit
information to members.

Course Description:

Learners will be presented with common benefit terminology and the categories of basic and complex benefits
and practice accurately categorizing and describing benefits. The new processes will be outlined so case
managers can identify when it is appropriate for them to provide benefit information and in what circumstances
a call should still be routed to a member service representative. A software demonstration of navigating the
database to locate benefit information will be provided and learners will then simulate navigation and apply
their learning by locating benefit information. Finally, learners will receive training on the teach-back method to
be able to identify if the member understands the benefit information.

Delivery

The training will be delivered in a blended format. A face to face training will be utilized to provide
an overview of the new policy and processes and address any apprehension. The classroom component will also
include readings, a PowerPoint presentation, and software demonstration to provide an overview of benefits,
navigating the database, communicating benefits and assessing a members understanding of the benefit
information. Several group activities, both large and small group, and partner work will be utilized for learners
to have the opportunity to apply their knowledge and skills. A manual on navigating the database and the
software demonstration with the step-by-step instructions on how to access benefits in the database will be
available for reference after the course.

Learner Characteristics and Considerations:

The learners are current case managers and currently utilizing the database that they will access benefit
information, although in a different capacity. Because this is a new policy and a job expectation change, the
training accounts for possible learner resistance to additional job duties and to the subject of benefits. Some
general characteristics of the earners are:

Adults, varying age range 25-72

Primarily female
Primarily full-time, salaried employees
Licensed nurses, social workers, and dieticians
Professional staff with several years of clinical experience
English speaking
Educated beyond high school, variance from bachelor to master prepared