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Case Management Programs
On a focused, time-limited basis, case managers assess, plan, implement, coordinate, monitor and evaluate treatment and support services to meet the medical, behavioral and high-risk maternal health care needs of identified members. Case managers or social workers educate members about their health conditions, coordinate health care services and serve as an advocate and liaison between members, their families or caregivers, physicians and other clinical staff on the health care team.
EmblemHealth case managers or social workers collaborate with primary care physicians, mental health professionals and high-risk obstetricians to ensure that each member’s complex and often competing medical needs are addressed and that care solutions are implemented. The Complex Case Management program assists medical professionals in meeting the needs of our members with acute, chronic and disabling conditions such as:
Transplants (solid organ and bone marrow)
Psychiatric and substance abuse (particularly those cases with significant psychiatric history)
Traumatic or catastrophic events
Care that supports your care plan
EmblemHealth's Complex Case Management program is a patient-centric approach to managing your patients' health care and service needs. Whether your patients have a relatively simple recovery, or one complicated by multiple chronic conditions, our complex case management team uses a multidisciplinary approach to support your patients and collaborate with you. Our complex case management team works with you and your patients to promote access to quality health care across the continuum and to ensure maximum health outcomes are achieved through individualized plans of care.
There is no additional cost for the case management services offered through our Complex Case Management program. Case management is voluntary and is a value-added program for your patients who meet eligibility requirements.
Learn more about our case management programs and the criteria for enrolling patients into the programs, by consulting the Provider Manual.
To refer a patient to the EmblemHealth Complex Case Management program, you may call 1-800-447-0768 or the phone number on the back of the member's ID card. To refer a high-risk maternity patient to the Healthy Beginnings PATH Pregnancy Management program, you may call 1-888-447-0337.
Please refer a patient with psychiatric and/or substance abuse issues to the appropriate behavioral health team:
For plans underwritten by GHI, call ValueOptions at 1-800-692-2489 to refer members to the Behavioral Management Program
For plans underwritten by HIP (including GHI HMO and Vytra), call ValueOptions at 1-888-447-2526 to refer members to the Emblem Behavioral Health Services Program.