Referral to Alliance Complex Case Management

Providers play a critical role in identifying members who may benefit from additional care coordination and support. 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

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

Referral Process
If you identify a member who may benefit from Complex Case Management services, please encourage a 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.