General resources for Community Plans (2024)

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Last Update: January 1, 2024, 8:00 a.m. CT

Information contained in the topics below provides information, resources, and links to help practitioners support our Community and State members and our Quality programs.

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Appointment accessibility standards

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As a reminder, UnitedHealthcare Community Plan has appointment availability requirements for PCPs and specialists. The requirements apply to routine, urgent and after-hours care. For specific information, please refer to your provider administrative manual, which can be found at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

Care management

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The UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.

What can the UnitedHealthcare Community Plan case manager provide for your patients?

  • Telephonic contact with members and facilitation of home visits
  • Health education and educational materials
  • A health assessment with stratification of diagnosis and severity of condition and
    psychosocial needs
  • Referral to community resources as needed
  • Assistance with medical transportation
  • Arrangements for durable medical equipment (DME) and ancillary services as needed or ordered by the physician
  • Outreach to members to promote assistance with keeping doctor's appointments
  • Work with members to identify and address barriers to seeking health care and following their medical treatment plan of care

How to refer
For more information or to make a referral, call our referral line at 877-542-9235.

Clinical guidelines

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UnitedHealthcare Community Plan has identified evidence-based clinical practice guidelines that are available as resources. The guidelines cover a variety of conditions, such as diabetes, asthma, depression, as well as preventive care. They can be found at UHCprovider.com/cpg or you may call 877-542-9235 for a copy.

Coordination of care between primary care practitioners and specialists

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UnitedHealthcare wants to underscore the importance of ongoing communication between primary care providers (PCP) and specialists. PCPs and specialists share responsibility for communicating essential patient information regarding consultations, treatment plans and referrals. Relevant information from the PCP should include the patient's history, diagnostic tests and results and the reason for the consultation. The specialist is responsible for timely communication of the results of the consultation and ongoing recommendations and treatment plans.

The information exchange between practitioners should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information and is a critical factor in providing quality patient care.
The provider administrative guide addresses coordination of care and expectations of our providers. For more information, please refer to the provider administrative guide for the applicable state at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

Member rights and responsibilities

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Just a reminder, the UnitedHealthcare Community Plan member rights and responsibilities can be found in the care provider manual. Member rights and responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their member rights and responsibilities.

Pharmacy updates

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UnitedHealthcare Community Plan pharmacy updates are available at UHCprovider.com > Menu > Health Plans by State> select state > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.

You can find this information online:

  • A list of covered pharmaceuticals, including restrictions and preferences
  • Pharmaceutical management procedures
  • Explanations on limits or quotas
  • How to submit and support special requests
  • Generic substitution, therapeutic interchange and step-therapy protocols

Call the pharmacy hotline at 800-922-1557.

Support for Language Services

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UnitedHealthcare Community Plan serves a diverse group of individuals. Each state within UnitedHealthcare Community Plan has unique membership that has its own cultural and language needs. Information about our membership is collected and analyzed in order to provide our members with healthcare services that meet their individual cultural and language needs. An example of some of our diverse membership by state can be found in the table below:

State

2nd language

3rd language

4th language

5th language

6th language

7th language

Arizona

Spanish

Vietnamese

Arabic

Chinese

Persian

-

Florida

Spanish

Creole

-

-

-

-

Hawaii

Chinese

Ilocano (Filipino)

Korean

Vietnamese

Tagalog

-

Indiana

Spanish

-

-

-

-

-

Kansas

Spanish

-

-

-

-

-

Kentucky

Spanish

-

-

-

-

-

Louisiana

Spanish

Vietnamese

Arabic

-

-

-

Maryland

Spanish

Vietnamese

-

-

-

-

Michigan

Arabic

Spanish

Bengali

-

-

-

Minnesota

Spanish

Hmong

Karen

Somali

--

Mississippi

Spanish

-

-

-

-

Missouri

Spanish

-

-

-

-

-

Nebraska

Spanish

Arabic

Vietnamese

-

-

-

New Jersey

Spanish

Korean

Arabic

-

-

-

New York

Spanish

Chinese

Russian

Korean

French

Haida

North Carolina

Spanish

Arabic

RussianVietnamese--

Ohio

Spanish

Nepali

Arabic

Somali

Swahili

Burmese

Pennsylvania

Spanish

Arabic

Cambodian

Russian

-

-

Rhode Island

Spanish

Portuguese

-

-

-

-

Tennessee

Spanish

-

-

-

-

Texas

Spanish

Vietnamese

-

-

-

-

Virginia

Spanish

Arabic

Vietnamese

Amharic

Persian

Urdu

Washington

Spanish

Russian

Vietnamese

Ukrainian

Chinese

Korean

Wisconsin

Spanish

Hmong

Arabic

Burmese

Somali

Chinese

UnitedHealthcare supports our practitioners in their efforts to provide culturally appropriate care by providing cultural competency training and language services to effectively communicate with our members. Language assistance is available to help providers communicate with members. Services include a telephone language line, in-person interpreters, and video services. We also have tools to promote cultural awareness and assist practitioners in recognizing and treating health disparities.

VisitUHCprovider.com/en/resource-library/patient-health-safety/cultural-competency.htmlto find our more information and to access the following tools:

  • Quick reference guide – Understanding Cultural Competency and the Americans with Disabilities Act
  • The Cross-Cultural Health Care program
  • Cultural Orientation Resource Center

You may also call877-542-9235to get more information on how to obtain language assistance and interpreter services for our members.

Utilization review

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UnitedHealthcare Community Plan staff performs concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. The Prior Authorization and Notification tool provides a listing of services that require prior authorization. You can learn more about the tool at UHCprovider.com/paan. Training is available in the Videos and Training section of the website. A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.

If you have questions or would like specific utilization management criteria, you can talk to our staff. Call toll-free at 877-542-9235. Staff is available 8 hours per day from 9 a.m.–5 p.m. ET.

General resources for Community Plans (2024)

FAQs

What is resources in community action plan? ›

In other words, the plan describes what your group wants to accomplish, what activities are needed during a specified timeline, what resources (money, people and materials) are needed to be successful. Steps for completing the community action plan.

What are the resources found in a community? ›

To put it simply, community resources include people, places, activities and things. They could be businesses, organizations, public service institutions or individuals in the community. Community resources can also be funded in a variety of ways.

What are the 5 main steps to solve community based problems? ›

Then each group should:
  • Determine the problem.
  • Think of several possible solutions to the problem.
  • Consider the consequences for each of their solutions.
  • Pick the solution they think will work the best.
  • Present their solution to the class.
Mar 10, 2017

What do you mean by community resources? ›

Community resources are defined as any assets that can be used to meet health needs and include human, financial, material, and time resources. Key human resources are health workers, volunteers, and community organizations, while financial resources include funds from governments and organizations.

What is a resource in an action plan? ›

Action plan resources: These are the inputs required to execute the plan, e.g., labor, time, tools, and funds. Identifying action plan resources before delving into execution helps ensure tasks are not delayed or compromised due to resource constraints.

What is a resource plan? ›

What is a Resource Plan? A resource plan identifies, organizes, and lists the resources required to complete a project. Because most organizational expenses are resource related, it's essential that they're used as efficiently as possible. A resource plan maps out how and when company resources will be used.

What are 4 problems in the community? ›

Example Community Problems: Adolescent pregnancy, access to clean drinking water, child abuse and neglect, crime, domestic violence, drug use, pollution, mismanagement of resources, lack of funding for schools and services, ethnic conflict, health disparities, HIV/ AIDS, hunger, inadequate emergency services, ...

What are five way to improve your community? ›

Here, we'll provide 5 unique ideas around how to make a difference in your community, and ultimately, nurture your social wellness.
  1. CREATE A LOCAL STIMULUS BOARD. ...
  2. LAUNCH A COMMUNITY ARTWORK INITIATIVE. ...
  3. POST A “NEIGHBOR IN NEED” LIST. ...
  4. TIDY UP YOUR COMMUNITY. ...
  5. DONATE, DONATE, DONATE.

What are the 4 basic problem solving processes? ›

The four steps are as follows:
  • Analyze—Understand the root cause.
  • Plan—Determine how to resolve the problem.
  • Implement—Put the resolution in place.
  • Evaluate—Determine if the resolution is producing the desired results.
Jan 26, 2021

What are the common resources in a community? ›

The commons are things that we all own jointly and that are neither privately owned nor controlled on our behalf by the government. Forests, fisheries, oil fields, grazing lands, irrigation systems, and other resources are examples of common resources.

What are type of resources? ›

Resources are characterized as renewable or nonrenewable; a renewable resource can replenish itself at the rate it is used, while a nonrenewable resource has a limited supply. Renewable resources include timber, wind, and solar while nonrenewable resources include coal and natural gas.

Why is it important to know community resources? ›

Community resources are necessary as they introduce you to typical and new experiences. Break out of your comfort zone through exposure to new routines, engage your talents, and explore previously suppressed social, cultural, and intellectual pursuits.

What is a resource in a project plan? ›

A resource is a necessary asset whose main role is to help carry out a certain task or project. A resource can be a person, a team, a tool, finances, and time. Most projects require many different resources to be completed. Resources should be assessed and allocated before a project begins.

What are resources in CAFS? ›

- defining resources. Resources can be defined as anything an individual, group or community can use to survive, accomplish a task, satisfy a need or a want or achieve a goal. In other words, a resource is anything that will help a person to live their life.

What is the action of resources? ›

Resource action means any a resource change or addition proposed by a utility in a formally docketed proceeding.

What is a resource based community? ›

Resource-based communities often depend on a single industry such as forestry, mining, petroleum extraction, or fishing. Closely tied to resource activities, they have unique social and economic characteristics, partly due to their small size, geographical isolation, and integration with the natural environment.

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