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Case Management

Case management is a collaborative process that provides members with health management support through a variety of coordinated programs. It is offered as a confidential and free program to members with our health coverage who are experiencing complex health issues or challenges in meeting their health care goals.

Case management is an ongoing process of working with members, their families, health care providers, and community resources. Case managers work step by step to:

  • Identify members who could benefit from case management and contact them via telephone.
  • Assess the member's current health status and history by asking various health-related questions.
  • Confirm if the member has case management needs and explain how AmeriHealth's case management programs can assist a member in managing his or her health.
  • Develop a care plan designed to meet the specific needs of the individual member. The case manager may utilize home care or educate and coach the member on lifestyle changes to support independent health management.
  • Follow up with the member, his or her family, and physician at the specific intervals (e.g., weekly, monthly) to review and enact the plan until all goals are met or case management services are no longer appropriate.
  • Discharge the member from case management once all identified needs have been adequately met and goals achieved or when case management services are no longer appropriate. Members can continue to contact the case manager at any time.

A case manager is available to help you with your complex needs. If you feel you may benefit from this program, please call a case manager at 1-800-313-8628.

Who are case managers, and what do they do?

Nurses and social workers work as case managers. They work with you over the telephone to educate, help, and support you.

How can I benefit from case management?

Case managers provide you with information and direction about health issues, health coverage, available community resources, such as help with transportation, and much more. They can help make sure you are getting the best use of the covered services available to you.

How do I find my case manager, or does my case manager find me?

A case manager may contact you by telephone or letter following a hospital or rehabilitation stay. Alternatively, if you need to talk to a health professional about a health-related issue or have health care needs and require assistance, you can contact a case manager yourself. Call 1-800-313-8628, and leave a message. A case manager will return your call as soon as possible.