Case Management & Disease Management Programs

Below is useful information to fulfill your healthcare needs.

Case Management, Complex Case Management, the Complex Care Program and Disease Management programs are available for Jai Medical Systems’ members, who have serious medical conditions or have complex and/or special needs. Our Case Managers can also assist with care coordination.

Currently, there are Disease Management Programs for Hypertension and Asthma. These Disease Management programs provide our members with additional information and support while helping them control their high blood pressure and asthma.

Case Management, Complex Case Management and the Complex Care Program services are also available to our members. Case Management, Complex Case Management and the Complex Care Program services provide support and guidance to those members that need or would like extra assistance with their health care.

How do I refer a member for Case Management and Disease Management Programs?

If you feel that one of our members may benefit from Case Management, Complex Case Management, the Complex Care Program or Disease Management services, please contact our Utilization Management team at 1-888-JAI-1999.

Below are some examples of medical conditions or circumstances where Case Management, Complex Case Management, the Complex Care Program or Disease Management may be helpful:

• People with multiple Chronic Conditions
• People with HIV or AIDS
• People who use the Emergency Room (ER) frequently
• Pregnant women and women who have recently had a baby
• Special needs children
• People with frequent hospital stays
• Individuals with developmental disabilities
• Individuals with physical disabilities
• People with behavior health issues along with medical conditions
• People with substance abuse problems
• People who need an organ transplant
• People with Asthma/COPD
• People with cancer
• People who need dialysis or who are receiving dialysis
• People with Diabetes
• People with Hypertension
• People who need special durable medical equipment
• People with Hepatitis C

Prenatal and Postpartum Care Programs

Jai Medical Systems offers resources to support our pregnant members through their pregnancy and postpartum period including connecting them to their own case manager who will be available throughout their pregnancy and postpartum period.  The case manager will be a nurse who our members can call to answer questions related to their pregnancy, their care, and to make sure that they are receiving the care that they you need.  Our case managers can also discuss if any additional programs may be helpful to the member during pregnancy.  These programs include the MOM program, Centering Pregnancy, Doulas, Home Visiting Services, and Healthy Steps.

Call 1-888-524-1999 today to find out more about the following programs*: 

• The MOM Program offers in-person case management for pregnant members who are currently or have previously used opioids. This program is designed to provide our members with extra resources for their health needs, treatment goals, and tools to help our members maintain a healthy lifestyle.
• Centering Pregnancy is offered at certain OB facilities to provide group sessions for pregnant members who want to receive care and education alongside a like-minded community.
• Doulas are trained professionals who provide physical, emotional, and informational support to pregnant members or members who are within 6 months postpartum.  Doulas can visit members in their home before and after they give birth.  They will also be available for members during their delivery.
• Home Visiting Services offer in-home support to our members during their pregnancy and the first few months of their baby’s life.
• Healthy Steps facilities offer additional support and resources to families with children 3 years and under. This program adds a child development specialist at the member’s pediatric primary care provider’s office.

Jai Medical Systems is here to help.

*Some programs may or may not be right for our pregnant members, please call our Case Management team at 1-888-524-1999 to learn more.