For Members with Highly Complex Needs

Similar to Neighborhood’s other case management programs, this program focuses on the coordination of services and goal-setting/treatment for members who have experienced a critical event or diagnosis that requires the extensive use of resources and who need help navigating the health care delivery system.

Who Might Benefit from Complex Case Management Services?

• High Risk Newborns discharged to home from a Level II nursery
• Individuals with an Inpatient stay greater than 21 days
• Individuals discharged from an acute rehabilitation or skilled nursing facility
• Individuals who have been discharged to home after having a transplant
• Individuals taking multiple medications with complicated treatment plans

What can the Neighborhood Complex Case Managers do for members?

• Support and reinforce members in their efforts to adhere to treatment interventions recommended by their health care providers.
• Advocate for members to obtain the most appropriate health care services available.
• Act as a liaison between all providers to enhance communication
• Educate members, families and health care providers regarding benefits, availability of services, community resources and health care alternatives
• Reduce barriers in order to maximize positive member outcomes

For more information or to make a referral to Neighborhood’s Case Management program, please call Neighborhood Customer Service at 1-800-459-6019.