Tuality Health Alliance assists our providers in managing those patients who may need a little extra guidance/help to stay healthy.
We have a staff of nurse case managers and community outreach specialists who can assist with complex clinical needs, member education, assistance with social conditions that affect health, and linkages to other organizations and agencies that provide additional services. For help with members who have special needs, please speak to our medical management department at 503-844-8104.
Our case management nurses provide clinical services which include:
- Monitoring and authorizing hospital admissions, both at Tuality Community Hospital and outside contracted facilities
- Complex case management for members with special needs
- Monitoring Emergency Department utilization and educating members about primary care provider relationships and medical homes
- Member education and guidance on health and wellness
- Regular visits with PCP and as needed for disease prevention and management
- Reducing Emergency Department utilization and encouraging use of PCP or urgent care
- Reducing hospital readmissions by encouraging compliance with provider’s plan of care and ensuring appropriate follow-up visits are scheduled and attended.
- Ensuring members have appropriate transportation for provider appointments and access to the pharmacy
- Encouraging medication compliance
Our community outreach coordinators work directly with the nurse case managers to provide the social supports that help determine our members’ ability to live healthy lives. They help with such items as:
- Assistance with transportation, housing, clothing, cell phone, and other basic needs
- Utilization of flexible funds to assist members with non-billable items that contribute to the member’s treatment plan
- Home visits to members with special needs
- Coordination with other agencies and non-profits that provide services to members in need
- PCP assignments and re-assignments