Care Manager - Maternal Child Health - Nicu

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Position Description

As the Care Manager

• Maternal & Child Health

• NICU, you will be responsible to coordinate and manage the care of newborns in the Neonatal Intensive Care Unit. You will collaborate with healthcare professionals, including physicians, nurses and social workers to ensure that infants receive comprehensive and high-quality care. As a NICU Care Manager, you will serve as an advocate for the infants and their families, facilitating communication and providing support throughout the NICU stay and during the transition to home and after.

• Provide telephonic-based case management for caregiver(s) of NICU newborns and/or newborn members requiring NICU inpatient care. Monitor medical conditions and length-of-stay for infants in the NICU, and assist as needed with transitions to lower level of care and/or discharge to home. Collaborate with hospital staff and member caregiver(s) as infant transitions through levels of care and acuity.

• Coordinate ongoing benefit and eligibility assistance as needed during hospital stay and transition to home. Partner with caregivers, primary care providers, and other relevant agencies to assure appropriateness of service that meets member needs and supports desired outcomes. Assist caregivers by removing barriers to appropriate primary and specialty care services following discharge.

• Provide ongoing Case Management support at home for several of the NICU discharged newborns. May continue ongoing case management and care coordination services after discharge to home.

• Assess maternal postpartum physical and mental health needs, and offer appropriate emotional support, education, and resource referrals for caregivers and families. Provide ethnic and culturally appropriate approaches to care planning as needed.

• Identify members eligible for NICU program and track clinical updates for currently identified infants requiring NICU Level III/IV care. Make internal and external program referrals as appropriate.

• Identify infants at risk for high-cost NICU care, perform clinical status review of identified members, and report status of high-cost NICU members during reinsurance monthly review.

• Understand and accurately interpret and apply relevant contractual requirements, policies, procedures and regulations for those members for which care management is a provided service.

• Document accurately, thoroughly, and timely in UCare's clinical documentation software.

• Meet and maintain all established caseload and performance metrics.

• Attend internal and external meetings; may act as team representative on cross departmental meetings as assigned.

• Assist with UCare's NCQA Complex Case Management program or other clinical initiatives as necessary.

• Support racial and health advancement goals as part of Clinical initiatives and UCare's anti-racism effort.

• Collaborate through team efforts to advance the Maternal & Child Health Case Management program.

• Other projects and duties as assigned.