Regence care manager serves members by bridging the gap between insurer and provider 

When people think of a health insurance company, they may think about claims or coverage, but at Regence, we have a team of medical professionals ready to help you. That includes our care managers. These are experienced registered nurses, behavioral health clinicians and social workers who are available to answer your questions and ensure you get the care you need.  

On this episode of HealthChangers, host Ashley Bach speaks with Jen Adkins, a registered nurse at Regence and care manager who is embedded with the Vancouver Clinic in southwest Washington. They talk about how Adkins is able to serve member needs through her unique role, working so closely with one of our provider partners.  

Listen to the full podcast episode on the player above. Below are some highlights, which have been edited for length and clarity.    

AB: Jen, before we get into your role, I wanted to talk about our care managers as a whole; it’s really amazing at Regence the breadth of care managers that we have. What is a care manager, and how do they serve members? 

JA: A care manager at Regence is generally a nurse or a licensed clinical social worker. We work with members facing medical issues, if they have complex care, if they’re having trouble accessing care. We really work with them individually, with the member, or even with the member’s family, to get them care. But we can also help them manage their medical conditions. Some of our patients have complex medical needs, and it’s hard to keep track of everything that they need to do to manage those needs. So, we’re a third party that really assists them making appointments, making sure they’re getting to their appointments. Do they have the resources? Do they have the rides? Just helping coordinate so that they get the care they need, and getting the care that they need really keeps them out of the hospital and keeps things manageable, and also lets them live a happier, healthier life. 

A lot of our members are unaware that there are care managers out there that are here to help them. Members are used to care managers in the hospital, and a lot of times in their outpatient clinics. I would say it’s rare for a health plan to have the dedicated level of care managers that we do. I think it’s important and helpful, and a huge benefit to our Regence members, but I don’t think it’s common and well known. 

AB: What is unique about your role as a care manager embedded at Vancouver Clinic? 

JA: That’s the really exciting part, and I would say innovative part, of my role is I actually work one-on-one with these doctors and nurses at the Vancouver Clinic. So I have access to their electronic medical record, Epic. I’m able to instant message with the doctors just as if I was an ER nurse in the emergency room. So I have that level of connection with the doctors in the primary care offices with the Vancouver Clinic.  

When I have a patient that’s struggling or having issues, I can directly message that doctor and either get them a referral to the PCP (primary care provider), let them know that their blood pressure is high; we’re having trouble filling medications, and maybe we need an adjustment in a medication. Maybe I need to get them in to see the provider sooner than they can when they call through the [provider’s] call center. That gives me leverage to be able to get these patients seen and taken care of faster. The providers also get to know me a little bit and know that I’m a nurse. And so these patients are being evaluated to a certain level by a nurse and not by an MA (medical assistant), where it has to go through three different channels.  

AB: I was looking at some of these stats that we’ve compiled. It’s really pretty incredible, the breadth of impact you’d be able to have, just in a year in your job. You started your role in June 2025. You’ve outreached to more than 200 Medicare Advantage members. You talked about closing care gaps and you’ve achieved about $170,000 in health care cost savings. How does it feel to see those numbers and that kind of impact? 

JA: It’s pretty cool. I think the impact for me is more the smaller stories that I get to see through. I think the numbers are great for people looking at why it’s valuable, but I think the most value is in the smaller stories of the patients where you’ve made just like a huge, huge difference in their life, and they’re just blown over by what one person can do.  

AB: What is an example of an area where you were able to make an impact in a member’s’ life? 

JA: It was a member who was trying to get a surgery that they needed. And I dug into it because he was confused, and he was just frustrated. And he had been working with [the provider’s] customer service, and I accidentally got the case because he came up in one of my lists. And because I have access to the provider’s EMR (electronic medical record) and our [Regence] system, I realized that there had been a clerical error when the provider was applying for this prior authorization. And this poor guy had been denied, and I figured it out, and I was able to escalate it. And we got his prior auth for this major surgery overturned within two days. Even the customer service representative, was like, “How did you do this?”  

And I was like, “Well, just some investigation.” And really it was a cardiologist, having access to his records and reading his notes, but then going in and reading the documentation that had been sent for the prior authorization that helped me realize there was a mismatch. So, without that access to the electronic medical record, I would have never been able to catch what was documented incorrectly so that we could overturn it. So that was huge. 

AB: Do you have any other examples of member impact? 

JA: When I first started out, one of the things I worked with was palliative care. So palliative care is not hospice, which is a misnomer. Palliative care is care that we get for patients with chronic illnesses. And it just helps symptom management in a different way than a lot of primary care providers understand.  

I had a patient who was chronically in the ER, just for different things, and one of the places I got them tapped into was palliative care, and I was able to do that by getting a referral from their primary care physician, and I said, “Hey, I’ve identified this patient; they keep going in for the symptoms. Their symptoms aren’t managed, and let’s get them referred to palliative care.” And so he got referred to palliative care and we saw an immediate drop in ER visits. His wife was much happier because he didn’t really want to go to the ER. That wasn’t where he wanted to end up, but his family didn’t know what else to do or who else to reach out to.  

AB: Are there any plans to expand the Regence embedded care manager program to other providers besides the Vancouver Clinic? 

JA: It’s been so successful this year that we are actively working to engage with other providers and have a similar setup; because it really does improve care, it improves access, and honestly, it improves relationships between our providers and Regence.