SCCP deploys licensed clinicians through tele-health, telephonic, and in-home engagement models to support quality improvement, chronic disease management, preventive care, and care transition initiatives.
Nurse Practitioner Services
Services include:
Our Nurse Practitioners provide clinically guided assessments and interventions that support quality measures, member engagement, and care coordination objectives.
- Advanced Care Planning (ACP)
- Annual Wellness Visit (AWV) support
- Care for Older Adults (COA)
- Medication Review
- Functional Status Assessment
- Pain Assessment
- Chronic disease counseling
- Clinical Risk Adjustment Assessments
- Blood pressure management support
- Diabetes education and follow-up
- Medication adherence support
- Health risk assessments
- Clinical escalation and referral support
- Telehealth quality assessments
Registered Nurse Services
Services include:
Our Registered Nurses provide clinical support and member follow-up designed to improve care continuity and reduce avoidable barriers to care.
- Services include:
- Clinical triage support
- Chronic disease follow-up
- Medication adherence support
- Transition of care outreach
- Member education
- Care plan reinforcement
- Clinical escalation review
- Coordination with primary care and specialty providers
Behavioral Health Clinical Services
SCCP’s behavioral health team supports members following behavioral health events and transitions in care.
Services include:
Follow-Up After Hospitalization for Mental Illness (FUH)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up After Emergency Department Visit for Substance Use (FUA)
- Post-discharge outreach
- Behavioral health engagement support
- Community resource navigation
- Coordination with behavioral health providers
SCCP’s Clinical Assessment and Care Coordination Program is designed to support:
- HEDIS performance improvement
- Medicare Star Ratings
- Medicaid quality initiatives
- Value-based care programs
- Risk-based contracting arrangements
- Population health management strategies
- Care management programs
- Health equity initiatives