AmeriHealth New Jersey Quality Management Program

AmeriHealth New Jersey's Quality Management (QM) program provides a formal process to systematically monitor and objectively evaluate the company's quality, efficiency, and effectiveness.

Program activities
  • Provide tools and information to assist network providers in developing and maintaining a standard of care.
  • Manage partnership with network providers.
  • Monitor and evaluate care.
  • Suggest improvement to medical policies.
  • Oversee credentialing.
  • Oversee various processes for hearing grievances and appeals.
  • Collect member suggestions for quality initiatives.
  • Monitor aspects of care based on the demographics of members served (i.e., age, gender, and health status).
  • Investigate and track potential quality of care concerns through the recredentialing, grievance and appeal, and peer review processes.

Member safety

We use plan-wide activities that increase member safety initiatives and reduce medical/medication errors. These activities include communicating information through mailings and newsletters.

Quality improvement

Members can request information about the Quality Improvement Program by calling the Member Services number on the back of the ID card.

Download more AmeriHealth New Jersey Quality Management Program information for members >