CFSP 5 Year Plan - RI Department of Children, Youth & Families

Activities of the Pediatric Case Management staff, including but not limited to the
identification and assessment of progress to meet short-term and long-term goals,
ongoing interaction with practitioners/providers, and conducting ongoing follow-up with
each member are documented in Neighborhood’s case management software and are
accessible to Utilization Management, Disease Management and all Case Management
staff.
Neighborhood’s case management software system allows for automated documentation
of the following for each interaction that occurs with the member: user ID (name of Case
Manager), date and time of the interaction. The case management software system
generates an automated follow-up schedule based on the short- and long-term goals
identified during the assessment. Case Managers are also able to build or modify the
schedule for follow-up outreach to the member based on their clinical judgment. Case
Management Care plans are available to the member, the member’s guardian /
representative, and/or the member’s practitioner(s) or provider (s) upon request. Members
have the right to decline participation or disenroll from Neighborhood’s case
management programs and services at any time.
The Case Management staff work collaboratively with and communicate with network
practitioners, hospitals, external resources, and state and community agencies, including
but not limited to DCYF, CEDARR Family Centers, WIC, and the Adolescent Self-
Sufficiency Collaborative, to assure coordinated care and treatment plans for members.
E. CSN-SUB Enrollment Screen Procedure:
1) Cases will be assigned to the Pediatric Case Management Team
twice a week via an assigned episode of care in the Case
Management Software System by the Team Lead or designee.
2)Upon referral or identification using Neighborhood’s data sources that a member is
eligible for enrollment in Neighborhood Health Plan a Case Manager or Care
Coordinator outreaches and completes an initial assessment of the member within 45
days of the members’ effective date of enrollment. If the Case Manager or Care
Coordinator is unsuccessful in reaching the member or family after three (3) failed
telephone phone call attempts a “Call Me” letter is sent to the member with a request to
follow-up / contact Neighborhood’s Case Management staff. Cases left open after 30
days are closed.
3) Case Managers review the following prior to initiating contact with the member:
a. Prior events / history of the member’s experience in Neighborhood’s case
management programs;
b. Medical and pharmacy claims history;
c. Any relevant detail available and/or submitted with the program referral to
better understand the member’s case.
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