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Case Management

If you’re managing a serious health condition, our registered nurses can help you better understand your diagnosis, so you can follow your doctor’s treatment plan.

About the program

The Case Management Program provides eligible Horizon BCBSNJ members the education and guidance they may need when faced with a complex medical situation 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

Our trained Care Managers are fully licensed health care professionals and registered nurses. They will work with you and your treating doctor so that you have access to the best care possible.

Through the program, our Care Managers can:

  • Regularly discuss your overall medical situation with you and your doctor(s)
  • Provide educational material, advocacy and professional guidance about managing your health and information about your medical condition
  • Help you locate and coordinate appropriate care for your needs
  • Assist you in understanding how to maximize your plan benefits to minimize your out-of-pocket costs related to your condition

For some categories of Case Management, Horizon BCBSNJ offers specialty programs. Select the Specialty Case Management Programs tab to learn more.

Who is eligible?

This is a free and voluntary program available to all eligible Horizon BCBSNJ members. Prior Authorization may be required.

How to join

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. If you have hearing or speech difficulties, please call the TTY/TDD line at 711.

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.