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Case management

Our Case Management program offers support, guidance and valuable information to help you manage a complex medical situation. Our specialty case management programs include our High-Risk Maternity, Post-Discharge Contact and Organ Transplant programs

About the Program

  • A high-risk pregnancy or a newborn with medical issues.
  • A cancer diagnosis.
  • The need for heart surgery, an organ transplant, ventilator management, extensive home care or home infusion.
  • A severe injury or paralysis.

Specialty Case Management Programs

Within Horizon Blue Cross Blue Shield of New Jersey’s broader Case Management program are the following specialty programs:

High-Risk Maternity Program
This program is designed to assist eligible Horizon BCBSNJ members with high-risk pregnancy conditions. An experienced high-risk Obstetrical Care Manager will call you and provide nursing guidance and related education throughout your pregnancy.

Your Care Manager will:

  • Contact you to request permission for enrollment into the program.
  • Contact your obstetrical and/or maternal-fetal medicine specialist to obtain clinical information and your care plan.
  • Monitor the clinical progress of your pregnancy with follow-up calls to the doctor(s).
  • Help your doctor(s) obtain required authorizations for services (when appropriate).
  • Provide ongoing educational information and nursing guidance by phone during your pregnancy and postpartum period (about six weeks following delivery).

If you need these services, please ask your treating doctor to call the appropriate prior authorization number for assistance.

Members can also be referred to our Case Management Program from other departments at Horizon BCBSNJ, including our Utilization Management department and Chronic Care Program department, the 24/7 Nurse Line, as well as, rehabilitation facilities, facility discharge planners, behavioral health providers, practitioners, caregivers and pharmacy vendors.

Your Care Manager will:

If you are a member who anticipates needing additional services following an upcoming hospital stay, please ask your treating doctor to call the appropriate prior authorization number for assistance.

Organ Transplant Program
If you're an eligible Horizon BCBSNJ member and you’ve elected to be an organ and/or tissue donor or transplant recipient, you qualify for our Organ Transplant Program, which will help you get the education, support, and services you need throughout the transplant process. This is a voluntary program available to all Horizon BCBSNJ members at no additional cost.

Most participants enrolled in the program are referred by their doctor. However, eligible Horizon BCBSNJ members may also request Case Management services.

Please call 1-888-621-5894, option 2, for information about participating transplant facilities, to request educational materials, or to seek help from a Care Manager.

  • Contact you when discharged from the hospital.
  • Communicate your health care needs directly to your doctor.
  • Help your doctor obtain authorization for services (when required).

FAQ

Are all Case Management Programs free?
Yes, all programs are free to eligible members of Horizon Blue Cross Blue Shield of New Jersey. Participation in the programs will not affect your premium or your status with the plan.

What types of medical issues do these program deal with?
The Case Management Program is for members facing a life-changing medical condition, such as:

  • A high-risk pregnancy or a newborn with medical issues.
  • A cancer diagnosis.
  • The need for heart surgery, an organ transplant, ventilator management, extensive home care or home infusion.
  • A severe injury or paralysis.

What if I join the program and then decide not to participate?
All programs are completely voluntary. You can contact us at any time to cancel your participation.

Is my health information kept confidential?
Yes, we always work to ensure that all of your personal health information remains confidential.

Are DME (durable medical equipment) and prescriptions covered?
DMEs and prescriptions are not covered as part of this program, but they may be available as part of your health benefits plan. Check your plan information for details.

How was I identified for this program?
You may have been identified either through claims data, pharmacy data, your doctor's referral or case management.

Members can be referred to our Case Management Program from other departments at Horizon BCBSNJ, including our Utilization Management department and Chronic Care Program department, the 24/7 Nurse Line, as well as, rehabilitation facilities, facility discharge planners, behavioral health providers, practitioners, caregivers and pharmacy vendors.

Can I enroll on my own?
Eligible Horizon BCBSNJ members may enroll themselves or an eligible dependent in the Case Management Program by calling 1-888-621-5894 and selecting option 2. Representatives are available for assistance Monday through Friday, from 8 a.m. to 5 p.m., Eastern Time.