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Case Management Services

 

Alaska Medicaid, through their contractor Qualis Health, provides case management services designed for patients with serious illnesses, injuries, and some chronic conditions. Qualis Health's nurse case managers assist recipients and their families with obtaining needed health care and other related community services. To improve health outcomes, nurse case managers advocate on the recipient's behalf for high quality, cost-effective health care. Participation in the case management program is voluntary and requires the recipient's consent for participation. There is no obligation and no penalty for choosing not to participate.

Types of Conditions for Case Management Services

Examples of the types of situations that may benefit from case management assistance include:

  • Chronic illnesses such as diabetes, asthma, and congestive heart failure
  • Acute catastrophic injuries, such as multiple trauma, head injuries, spinal cord injuries, and amputations
  • Burns, wounds, and non-healing ulcers
  • Organ transplants
  • Cancer
  • Terminal illnesses
  • Neonatal complications

Referrals for Case Management Services

Case management services can be initiated through the Prior Authorization review process or upon request from:

  • a recipient or his/her family member
  • a recipient's physician, hospital, or other medical provider
  • Xerox State Healthcare
  • Community, state, or other agencies

Case Management Services

Upon receiving a referral, a Qualis Health nurse case manager will contact the recipient and/or family to discuss his/her health care needs. Available Case Management Services include:

  • Assessing the recipient's personal situation and challenges
  • Providing information, resources, and referrals to support treatment and coverage options
  • Working with the recipient, his/her family, physician, and other medical providers to develop a coordinated care plan for management of the recipient's illness or injury
  • Coordinating services provided by the professionals involved in a recipient's care to work together to best meet health management goals

For additional information regarding Case Management Services, contact Qualis Health at :

(907) 770-7525 or (888) 578-2547
Monday -Friday, 8:00am - 5:00pm AK Time or
access their website at http://qualishealth.org

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