Case Management Services for Patients with Complex Needs

Summer 2019

Neighborhood has a case management program for members who have very complex needs. This program is for members who experienced a critical event or diagnosis and require many resources as well as help navigating the health care system. Like Neighborhood’s other case management programs, this program focuses on the coordination of care, goal-setting and treatment.

Who Might Benefit from Complex Case Management Services?

  • High Risk Neonates discharged to home from a NICU or Level 2 nursery stay.
  • Members with an inpatient hospital stay greater than 21 days that have been discharged home.
  • Pediatric members discharged home from a short-term rehabilitation or skilled nursing facility stay.
  • Adult members who have been discharged home after a length of stay greater than seven days in a short-term rehabilitation facility.
  • Members who have been discharged to home after having a transplant.
  • Pregnant members with substance use disorder

What can the Neighborhood Complex Case Managers do for members?

  • Help members stick to treatment plans recommended by their providers.
  • Act as a liaison between all providers to help communication and advocate for members to get the most appropriate health care services available.
  • Teach members, families and providers about benefits, availability of services, community support, and health care alternatives.
  • Reduce barriers to increase positive member results.

For more information about our case management programs, or to refer a member, please call us at 1-800-459-6019.