Central California  Alliance For Health

 

Complex Case Management and Care Coordination


Complex Case Management

The Complex Case Management team is a multidisciplinary team comprised of nurses, medical social workers, and care coordinators who partner with PCPs to provide the following support for members for up to a 6-month period:

• Comprehensive assessments

• Promotion of the Patient-Centered Medical Home by facilitating a
  safe connection between our members and their PCPs

• Care coordination

• Promotion of health self-management efforts


• Referrals to community resources

• Mutually agreed-upon care plans that include targeted
  interventions.

• Patient engagement through phone and in-person encounters


What is suitable for referral to Complex Case Management Services?

(please note this is not an exhaustive list)


Chronic Illness Catastrophic Diagnosis Medical Issues
Poorly controlled chronic illness or new/worsening complications (e.g., asthma and diabetes)

Obesity/bariatric patients

Medication reconciliation

Multiple admissions (excludes cancer)
Complex injuries

HIV/AIDS (new diagnoses and unlinked)

End of life
Complicated wounds

Stroke with complications

New or worsening debilitating disease (e.g., Multiple Sclerosis, Parkinson’s Disease)

Seizure disorder with complications


What is not suitable for referral to Complex Case Management Services?

(please note this is not an exhaustive list)


Members with other health care coverage Members with disruptive, violent, or abusive behaviors Members who are unable to be reached or who refuse to participate Members in long term care

Care Coordination

The Care Coordination team assists members with less complex, non-clinical needs by providing:

• Referrals to community resources and services.

• Follow-up care with specialists, including referrals for ancillary
   services and durable medical equipment (DME)

• Assistance with making and keeping appointments

• Assistance with the retrieval of medical records

• Linkage to transportation resources

• Children’s case management for members less than 21 years old
   with special health care needs who require assistance and
   linkage to services

Providers can refer Alliance Members to Care Management Services, including Complex Case Management and Care Coordination, by calling Case Management at (800) 700-3874 ext. 5512 or by faxing a completed referral form (see link below) to (831) 430-5852, ATTN: Case Management.


Case Management Fillable Referral Form



 

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