Case Management
Our clinical experts balance quality of care for members while maximizing plan savings
American Health’s URAC-accredited Case
Management services are designed to improve the quality of patient care while maximizing cost savings. Our Utilization Management triggers
cases that may benefit from Case Management intervention, helping to facilitate early identification, prevent rehospitalization and significantly
reduce costs. American Health case managers are registered nurses and licensed social workers who function as advocates, facilitators and educators,
ensuring that members receive appropriate care at the right time, the right setting and the right cost.
Our experienced clinicians:
- Collaborate with providers to ensure the member receives high-quality, cost-effective care
- Complete telephonic assessments that assist in determining the member’s needs and requirements
- Review treatment plans for medical necessity and standards of care
- Help members and their families understand what to expect during the course of treatment
- Supply education materials about treatment options
- Assist members and families in understanding available benefits
- Steer members to network providers
- Work closely with stop loss carriers to manage high-cost, complex cases
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Read Jason and Kelly's story and other case studies
See what our members have to say about Case Management
Product Highlights
- Comprehensive approach to patient-focused support and life management
- Dedicated case managers interact with patients and families, offering a complete support network
- Experienced case managers supported by American Health’s board certified medical director and a panel of board certified, practicing physician specialists
- We report all never events and avoidable hospital conditions
- Mitigating plan exposure and providing group- and member-specific reporting
