Case Management
Anthem Blue Cross and Blue Shield Medicaid (Anthem) case managers help make healthcare easier and less overwhelming for our members. They work with our members to help them understand the types of services we offer to them and how to participate in their own care.
Our licensed clinical staff uses evidence-based Clinical Practice Guidelines to help create a plan of care in collaboration with the member and their treating providers. We update providers about outreach in order to monitor progress. We offer information to help providers coordinate care, prevent hospital readmissions and improve the member’s health outcomes.
Your patients may already be working with one of our case managers. If not, or if they need help contacting their case manager, please have them call Member Services :
Our case managers may call our members if:
- They or you, their healthcare provider, think case management might help the member.
- They’ve just gotten out of the hospital and need help with follow-up visits to other doctors.
- They’re going to the emergency room (ER) often for nonurgent care that could be handled by you, their healthcare provider.
- They call our 24/7 NurseLine and need more follow-up for ongoing care.
- They have serious physical problems and need more help managing their health.
- They have behavioral health problems and need more help working with all of their doctors.
Case managers can also help with:
- Setting up healthcare services for the member.
- Getting referrals and prior authorizations.
- Checking a member’s plan of care.
From time to time, members may have questions about calls they receive from one of our case managers. When we call, a nurse or social worker will:
- Always identify themselves with their name, title and position with Anthem.
- Tell the member about the services we offer.
- Talk to the member about their health and how they’re handling different parts of their life.
Our case managers are here to help you. If you have a member in your care who would benefit from case management, please call Provider Services at 1‐855‐661‐2028. Members can also call our 24/7 NurseLine at 1-866-864-2544, available 24 hours a day, 7 days a week.
Related resources:
- Please refer to your provider manual for additional information regarding case management for Anthem members.
- Learn more about our New Baby, New LifeSM case management and care coordination program for new and expecting mothers on the Pregnancy and Maternal Child page.
- Head to our Condition Care page to learn more about our case management program for chronic conditions.