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Optum Complex Case Management Program

Optum offers a Complex Case Management program for members who could be helped through more intensive coordination of services. This program is intended to help members with complex behavioral health conditions connect with needed services and resources. Care Coordinators work intensely with individuals in the development of a comprehensive plan of care which coordinates the following:

  • Therapeutic services (therapy, medication management, case management, etc.)
  • Community and Social Determinants of Health supports (education/support regarding illness, coordination with support system, other supportive services)
  • Coordination of care between medical and behavioral physicians and clinicians
  • Recovery and Resiliency Services (peer support, development of a crisis/recovery plan, life planning activities)
  • Other services as appropriate (legal, shelter, basic needs, etc.)

Program Goals:

  • Improving functional health and well-being
  • Supporting recovery from mental illnesses and/or substance use disorders

Criteria for acceptance into the program include:

  • Presence of complex behavioral health condition(s) which require intensive coordination of services
  • History of intensive behavioral health service utilization over the past 12 months
  • Member willingness to actively participate in the program for at least 90 days

If an individual with whom you are working meets these criteria and may benefit from Optum’s Complex Case Management program, please contact us at to make the referral. Optum looks forward to collaborating with you to assist your patient/client on the path to recovery and wellness.