Condition and Case Management

Condition Management

Recognizing that the physician-patient relationship is at the heart of patient care, the condition management program is designed to help providers and their patients manage chronic conditions, support the providers’ relationships with their patients, and do the following:

  • enhance the provider’s ability to provide integrated care for their patients
  • provide members with evidence-based information so they can understand their diagnoses and their health care options, while actively participating in health care decisions with you
  • promote integration of care among members and their family, physicians, Health Coach, social workers, and community resources

Case Management

Sometimes patients need extra support when they are dealing with an acute illness, a chronic condition, or multiple comorbidities such as, Diabetes, CHF and Asthma. Often, they look to their treating providers for this additional support.

Our registered nurse Health Coaches can collaborate with you to support your plan of care and the medical treatment goals you have established.

Eligibility

AmeriHealth New Jersey members who are covered through fully-insured employer groups are automatically considered eligible for the condition management. Members covered through certain self-insured employer groups may not be eligible for the program. Members can call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241) to verify their eligibility.

Provider Rights and Responsibilities

Our condition management program values the importance of the physician-patient relationship and is designed to enhance evidence-based care. The program is based on open and collaborative communication among the provider, his or her patient, and the Health Coach. We ask all participating providers to review their rights and responsibilities.

Quality Management

See how AmeriHealth New Jersey upholds the highest standards of care with our quality management promise.