Referral to Alliance Complex Case Management (CCM)

About the Program

Alliance Complex Case Managers use clinical data, risk stratification, and provider input to identify members who would benefit from enhanced care management services.

The program supports members by:

• Coordinating care across multiple providers and settings
• Connecting members to medically necessary and community-based services
• Assisting with locating local resources and providers
• Educating members on how to access and manage their care
• Monitoring progress to ensure care needs are being met

Providers play a critical role in identifying members who may benefit from additional care coordination and support. CCM is available for members who are assigned to Alliance as their Health Plan and  assigned to Alliance as their TCM Provider. Members assigned to CMA’s  and AMH+ practices as their TCM Provider are not in this inclusion criteria.

Please consider referring members to Alliance Health’s Complex Case Management program when they meet any of the following criteria.

• Diagnosis of a serious or complex medical condition
• Frequent hospitalizations or emergency department utilization
• Multiple chronic conditions requiring coordinated care
• Difficulty accessing or navigating healthcare and community resources
• Need for additional clinical or social support to manage health needs effectively

Referral Process

If you identify a member who may benefit from Complex Case Management services, please encourage referral to Alliance Health.

• Providers may direct members to contact Member and Recipient Services at 800-510-9732
• Providers may also initiate referrals through connecting with member’s established Alliance tailored care manager.