Knowledge regarding the services and resources in the community that are appropriate to the needs of pregnant women and their newborns

Knowledge regarding prenatal care, pregnancy-related issues, and newborn care

Knowledge on the content and use of the CPSP Protocol Manual, Steps-To-Take Manual, and the CPSP Provider Handbook

Knowledge of the available benefits and eligibility to enable the patient to access total CPSP services

Comprehensive Perinatal Services Program (CPSP) Scope of Services includes:

• Provide a CPSP Orientation to orient the client to comprehensive perinatal care at entry of care and through the pregnancy

• Complete a CPSP Initial Assessment for the three components of Nutrition, Health Education, and Psychosocial using approved documentation, forms and protocols.

• Develop and complete a CPSP Individualized Care Plan (ICP) and continually revise and update the ICP as needed.

• Provide a CPSP-approved Interventions such as services, classes, counseling, referrals, and instructions as appropriate for the patient’s needs and risks as identified on the ICP

• Provide a CPSP Reassessments in each trimester to identify changes or new developments since the previous Assessment and provide continued support

• Provide a CPSP Postpartum Assessment of the mother and infant and update the ICP with appropriate interventions for the patient and her baby

Facilitate internal referrals to Communicare OLE Health Medical Providers, Registered Dietitian Nutritionists, Social Workers, Health Educators, Dentists, Patient Services Representatives and other appropriate services as necessary

Facilitate external community referrals to appropriate perinatal support services (i.e. WIC, etc.) as necessary

Maintain ongoing contact and case management with patients through face-to-face appointments, classes/groups, and phone calls regarding referrals, appointments (including no-shows and cancellations), labs, services, programs, agencies, and support

Provide group education on a variety of topics, including, but not limited to, breastfeeding, newborn care and childbirth preparation. Develop and implement curricula for classes as needed

Serve as liaison with health plans; screen for and issue temporary Medi-Cal (Presumptive Eligibility); follow up with patients until permanent Medi-Cal has been issued

Complete CPSP-required documentation according to protocol for all patient encounters (face-to-face and telephonic) and activities in the in Communicare OLE Health’s electronic health record

Complete all required Bill for services following CPSP guidelines and protocols related to units of service and subject area

Assist with data entry, data tracking, review and closure of CPSP patient charts

Check work email and organizational communications daily

Communicate patient ICP with Napa/Solano County Maternal and Child Health Department as needed. Attend and participate in case management meetings with Public Health Department

Participate in Napa/Solano organizations and groups (i.e. Napa Breastfeeding Coalition, etc.) as assigned

Represent and market Communicare OLE Health Perinatal Services at community events as assigned

Attend all in-service and trainings as assigned

Performs other duties as assigned