Specialty Case Management Programs

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. Within Horizon BCBSNJ’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.

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.

Additional services

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.

Your Care Manager can:

  • 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).

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.