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Case/Care Management - Lynchburg, Care Transitions Intervention, Central Virginia Alliance for Community Living

Take Charge of Your Health is a Care Transitions Intervention Program that helps high-risk patients manage their medical conditions and avoid unnecessary hospital readmissions. Health Coaches work individually with participants to provide health education, medication management, support to follow through with medical care, and connections to other community-based services. If needed, access to medical equipment and emergency medication is also provided. The program's goal is to empower individuals to "take charge" of their health by understanding and managing their conditions to the best of their abilities.

What's Here

Personal Health Care Advocate Services

Patient Services - Roanoke, Medical Liaison Services, Commonwealth Catholic Charities

Medical Liaison Services assist refugees and refugee eligible populations to navigate culturally and linguistically appropriate physical and mental health care in the community; coordinate efforts in providing education and information on the U.S. health care system to refugees; and, conduct outreaches to local health care service providers to discuss refugees' health care needs.

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Personal Health Care Advocate Services

Support Group-Disability/Health - Big Stone Gap, Mountain Laurel Cancer Support and Resource Center, Mountain Empire Older Citizens

Personalized cancer support and resources in a community-based, welcoming and private environment. Offers holistic help to cancer patients, survivors, their families, friends and caregivers. Provides patient navigation, travel assistance for medical appointments, liquid nutrition, pharmacy assistance and other financial help. Offers CancerHelp, a user-friendly database which contains the most up-to-date information about all types of cancer, cancer prevention, cancer screenings, cancer treatments and cancer research. Expands community awareness of and education about cancer issues, and enhances the quality of life of cancer patients, their family members and caregivers by addressing their psychological, social, emotional, spiritual and physical needs related to the impact of a diagnosis of cancer. Offers evidence-informed Understanding Cancer workshops through a partnership with University of Virginia Cancer Center.

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Health/Disability Related Support Groups
Chronic Disease Self Management Programs
Personal Health Care Advocate Services

Patient Services - Front Royal, Consumer-Directed Facilitation, Moms In Motion

Moms / AHYW is Medicaid-enrolled provider of CDSF services. SF team is responsible for supporting the person and family/EOR by ensuring the development and monitoring of the consumer-directed services plan of care, providing EOR management training, and completing ongoing review activities as required by DMAS for consumer-directed services. Make sure the person gets the services needed. Develop the service plan with the person and the EOR. Provide the fiscal employer agent (FA) the appropriate forms to start the process of establishing the EOR. Review this manual with the EOR. Submit requests for service authorization to the appropriate service authorization contractor. Train the EOR on the required tasks of an employer. Document services as required by the Department of Medical Assistance Services (DMAS). Assists the EOR when filling out paperwork for the Fiscal Employer Agent. Conduct reassessment visits. Conduct the annual level of care review process.

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Personal Health Care Advocate Services

Web Site - Washington DC, Amputee Coalition

Advocacy group dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss.

What's Here

Electronic Information Resources
Personal Health Care Advocate Services
Medical Equipment/Supplies