Case Management
 
Improves quality and reduces costs through timely discharge planning, alternative treatment options and negotiated rate reductions.

American Health’s Case Managers are accredited registered nurses who function as advocates, facilitators and educators, assuring that members make smooth transitions from inpatient settings to step-down facilities and home when appropriate.  Other American Health programs such as Utilization Management, High-risk Disease Management and Care Line (24/7 Demand Management) help facilitate early identification and notification to Case Management, resulting in significant savings. 

Case Management affects health care costs through:

  • education of patients and families on alternatives to costly inpatient care;
  • negotiation with caregivers to provide service at cost effective rates;
  • coordinating services to assure the smooth transition from hospital to step-down units and home care alternatives.
Fast Facts
  • American Health’s Case Management was one of the first to receive accreditation by URAC.
  • Case Managers have a minimum of 5 to 8 years clinical experience and prior medical or case management background with certifications in case management, rehabilitation or other specialty areas.
  • Case Manager specialties include:
    • Maternity/Newborn
    • Pediatric
    • Transplant
    • Oncology
    • Rehabilitation
    • Cardiac
    • Medical/Surgical
    • Psychiatric/Substance Abuse
  • Among the advantages of utilizing Case Management Specialists are:
    • greater access to centers of excellence or specialty care facilities
    • greater discounts
    • understanding of specialized care strategies
  • In addition to making use of their own expertise, the Case Managers have access to American Health’s Medical Director and full-spectrum specialty physician panel.
  • The program features online integration with American Health’s Utilization Management and Care Line (24/7 Demand Management).
  • The Case Managers work hand-in-hand with payors and reinsurance carriers to provide timely and on-going information on these high-cost cases, while maintaining appropriate confidentiality in keeping with HIPAA regulations.