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<br /> <br /> Page 37 of 48 <br />documentation is current throughout the period of time the care manager is working with the patient and should be <br />continually updated as new information is obtained. Participating Provider shall assign case status based on level of <br />patient need. <br /> <br />16.5 Care Management for High-Risk Pregnancy: Interventions. Participating Provider shall provide care <br />management services in accordance with program guidelines, including condition-specific pathways, utilizing those <br />interventions that are most effective in engaging patients and meeting their needs. This includes face -to-face <br />encounters (practice visits, home visits, hospital visits, community encounters), telephone outreach, professional <br />encounters and /or other interventions needed to achieve care plan goals. Participating Provider shall provide care <br />management services based upon level of patient need as determined through ongoing assessment. Participating <br />Provider shall develop patient-centered care plans, including appropriate goals, interventions and tasks. Participating <br />Provider shall utilize NC Resource Platform and identify additional community resources once NC DHHS has <br />certified it as fully functional. Participating Provider shall refer identified population to childbirth education, oral <br />health, behavioral health or other needed services included in the Covered Person’s WellCare network. Participating <br />Provider shall document all care management activity in the care management documentation system. <br /> <br />16.6 Care Management for High-Risk Pregnancy: Integration with WellCare and Providers. Participating <br />Provider shall assign a specific care manager to cover each Pregnancy Management Program provider within the <br />county or serving residents of the county. Participating Provider shall ensure that an embedded or otherwise <br />designated care manager has an assigned schedule indicating their presence within the Pregnancy Management <br />Program. Participating Provider shall establish a cooperative working relationship and mutually -agreeable methods <br />of patient-specific and other ongoing communication with the Pregnancy Management Program providers. <br />Participating Provider shall establish and maintain effective communication strategies with Pregnancy Management <br />Program providers and other key contacts within the practice within the county or serving residents of the county. <br />Participating Provider shall assure the assigned care manager participates in relevant Pregnancy Management <br />Program meetings addressing care of patients in the target population. Participating Provider shall ensure awareness <br />of WellCare Covered Persons’ “in network” status with providers when organizing referrals. Participating Provider <br />shall ensure understanding of WellCare’s prior authorization processes relevant to referrals. <br /> <br />16.7 Care Management for High-Risk Pregnancy: Collaboration with WellCare. Participating Provider <br />shall work with WellCare to ensure program goals are met. Participating Provider shall review and monitor WellCare <br />reports created for the Pregnancy Management Program and Care Management for High Risk Pregnancy services to <br />identify individuals at greatest risk. Participating Provider shall communicate with WellCare regarding challenges <br />with cooperation and collaboration with Pregnancy Management Program and non-Pregnancy Management Program <br />prenatal care providers. Participating Provider shall participate in pregnan cy care management and other relevant <br />meetings hosted by WellCare. <br /> <br />16.8 Care Management for High-Risk Pregnancy: Training. Participating Provider shall ensure that <br />pregnancy care managers and their supervisors attend pregnancy care management training offered by WellCare <br />and/or NC DHHS, including webinars, new hire orientation or other programmatic training. Participating Provider <br />shall ensure that pregnancy care managers and their supervisors attend continuing education sessions coordinated by <br />WellCare and/or NC DHHS. Participating Provider shall ensure that pregnancy care managers and their supervisors <br />pursue ongoing continuing education opportunities to stay current in evidence-based care management of pregnancy <br />and postpartum women at risk for poor birth outcomes. Participating Provider shall ensure that pregnancy care <br />managers and their supervisors utilize Motivational Interviewing and Trauma Informed Care techniques on an <br />ongoing basis. <br /> <br />16.9 Care Management for High-Risk Pregnancy: Staffing. <br /> <br />(a) Participating Provider shall employ care managers meeting pregnancy care management <br />competencies defined as having at least one of the following qualifications: registered nurse; or social worker with a <br />bachelor’s degree in social work (BSW, BA in SW, or BS in SW) or master’s degree in social work (MSW, MA in <br />SW, or MS in SW) from a Council on Social Work Education accredited social work degree program. Care Managers <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210