Care Coordinator

at  Steward Health Care

Position Purpose: The Maternal Newborn Care Coordinator will telephonically outreach to pregnant and postpartum members of Steward’s ACO population to improve outcomes and drive performance.

• Conduct ongoing telephonic care coordination for pregnant and postpartum members of Steward’s Accountable Care Organization. Responsibilities include but are not limited to:
• Outreaches the member and completing a comprehensive assessment to identify the member’s needs related to maternal newborn health, behavioral health, and the social determinants of health.
• Reviews available member information in electronic medical records and other sources.
• Refers the member to additional care management programs, community-based resources, and other supports as needed.
• Educates the member about basic healthy pregnancy and postpartum behaviors including the importance of prenatal, postpartum, and well-baby visits, as well as Steward’s benefits, incentives, and programmatic offerings.
• Collaborates with the patient’s care team including but not limited to hospital team, primary care team, specialists, home care, SHCN clinical programs, and any others involved with patients care and approved by the patient to ensure effective coordination of services and full understanding and execution of the care plan.
• Maintains required medical documentation for care management activities in the system’s care management module (electronic medical records), according to the standards of work.
• Follows standards of work and consistently maintains department established caseloads and timeframes for case completion.
• Documents and reports all quality and patient safety events by recording and adhering to all of Steward Health Care Network’s safety reporting guidelines.
• Support doula program operations as needed. Responsibilities may include but are not limited to:
• Provides regular updates to the National Senior Manager of Maternal Newborn Health Programs on members enrolled in the doula program.
• Assists with relevant quality improvement initiatives at Steward maternity hospitals.
• Participates in meetings with Steward’s doula care partner.
• Performs other duties as assigned

EDUCATION:

• Bachelor’s degree required
• Master’s degree in social work, public health, or related field preferred but not required
• Must maintain Basic Life Support (BLS) certification

YEARS OF EXPERIENCE:

• Minimum of 3 years working in a social or health care services environment with pregnant and childbearing families required

SPECIALIZED KNOWLEDGE:

• Experience providing direct services to pregnant and childbearing families. Specific experience in childbirth education preferred.
• Experience working with diverse, low-income and/or Medicaid populations with needs related to behavioral health and the social determinants of health. Specific experience in perinatal mental health preferred.
• Understanding of maternal newborn health issues —specifically related to pregnancy, childbirth, and the postpartum period—as well as basic newborn health care
• Excellent communication skills
• Experience documenting in electronic medical records or similar software, or ability to learn
• Fluency in Spanish preferred but not required
  Location: Steward Medical Group · 1185.72410 Managed Care
  Schedule: Full Time, Day Shift, Full Tim

• Conduct ongoing telephonic care coordination for pregnant and postpartum members of Steward’s Accountable Care Organization. Responsibilities include but are not limited to:
• Outreaches the member and completing a comprehensive assessment to identify the member’s needs related to maternal newborn health, behavioral health, and the social determinants of health.
• Reviews available member information in electronic medical records and other sources.
• Refers the member to additional care management programs, community-based resources, and other supports as needed.
• Educates the member about basic healthy pregnancy and postpartum behaviors including the importance of prenatal, postpartum, and well-baby visits, as well as Steward’s benefits, incentives, and programmatic offerings.
• Collaborates with the patient’s care team including but not limited to hospital team, primary care team, specialists, home care, SHCN clinical programs, and any others involved with patients care and approved by the patient to ensure effective coordination of services and full understanding and execution of the care plan.
• Maintains required medical documentation for care management activities in the system’s care management module (electronic medical records), according to the standards of work.
• Follows standards of work and consistently maintains department established caseloads and timeframes for case completion.
• Documents and reports all quality and patient safety events by recording and adhering to all of Steward Health Care Network’s safety reporting guidelines.
• Support doula program operations as needed. Responsibilities may include but are not limited to:
• Provides regular updates to the National Senior Manager of Maternal Newborn Health Programs on members enrolled in the doula program.
• Assists with relevant quality improvement initiatives at Steward maternity hospitals.
• Participates in meetings with Steward’s doula care partner.
• Performs other duties as assigne