The Case Manager is responsible for providing confidential, unbiased assistance to eligible LIBERTY Dental Plan (LIBERTY) enrollees of State Medicaid programs in need of dental services who also have a co-morbidity of special health care needs. Responsibilities also include, and are not limited to, assisting the Coordinators Care Management (CCMs) to perform their professional functions.

Key Responsibilities:

Inform enrollees of available covered dental benefits.
Help to resolve enrollee conflicts and barriers to dental care.
Assist in securing enrollee dental services.
Educate enrollees on their rights and responsibilities.
Provide enrollees the information on accessing the LIBERTY vehicles for complaints, appeals or grievance process.
Ensure enrollee cases and events are documented correctly in the Health Solutions Plus (HSP) database.
Manage telephone calls and email inquiries not limited to, seeking dental services, dissatisfaction, and second opinions.
Provide education pertaining to the LIBERTY Care Coordination Program.
Provide research and response to various inquiries.
Compose comprehensive written responses to all applicable inquiries.
Review and edit, as applicable, all State Agency Provider Network Verification File (PNV) responses prior to submission to LIBERTY Quality Management.
Perform LIBERTY process for enrollees in need of hospital services for dental issues, and delegate such performances to CCM, upon the CCM’s ability to accomplish.
Ensure all newly ascertained State Medicaid dental providers are directed to LIBERTY Provider Relations to insure credentialing.
Provide continual Care Coordination communications pertaining to the update and interpretation of state contractual directives for State Medicaid enrollees to the CCM.
Perform dental case turnaround time in accordance with access standards regardless of the communication route (e.g., HSP inquiry, workflow, email, facsimile, phone call, etc.).
Able to work collaboratively within remote locations.
Ensure compliance to all regulatory guidelines.
Comply with all LIBERTY corporate and department guidelines, policies, and procedures.
Ensures treatment plans and guardianship documents are attached to applicable enrollee HSP file. This is inclusive of shelter orders for foster and Medical Foster Enrollees.
Review dental care plans every six (6) months or per State contract requirement and ensure dental care plans are attached to enrollee HSP file.
Participate in Multidisciplinary Care Team meeting for LIBERTY State Medicaid enrollees, as applicable.
Perform other duties as assigned or determined appropriate.
The CM is not limited in providing customer care services when the need arises and may assist with other lines of business as directed and educated to perform.
The CM will work collaboratively with multi-divisions of LIBERTY such as and not limited to Member Services, Claims, Grievances, Staff Dentists, Supervisors, Managers and Leadership.
The CM will work collaboratively and interface with entities outside of LIBERTY such as Dental Offices, Primary Dental Providers and their representatives, health plan Care Coordinators, home and community-based service representatives, transportation vendors, hospital representatives, Primary Care Physicians or their delegates, legal representatives, varying State Government Agencies, Foster, Medical Foster and Community-Based Service providers.

Education / Experience:

Current valid license as a Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) in accordance with State of Residency.
4 years' experience as an LVN or LPN in public health, acute care, case management and/or in-home health care, preferably within Dental environment
2 years' previous experience in a Case Management position required.

What You’ll Need:

Care Coordination experience preferred.
Working knowledge of Microsoft Excel, Word and Outlook.
Capable of composing comprehensive written and verbal responses to inquiries.
Critical thinking skills to appropriately resolve inquiries, escalated cases and orchestrate holistic care.
Experience in conflict resolution and providing one-call resolution.
Bilingual English/Spanish, preferred. Able to pass a Spanish dental terminology exam.
Self-starter and a team player with strong organizational skills.
Must have a high degree of patience; excellent communication and interpersonal skills.
Excellent customer service skills.
Ability to work independently or in a team.
Please be prepared to Complete Online Skills Assessments as part of our application process

Location

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. This position requires residency in New Jersey.

What LIBERTY Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their society. That’s why LIBERTY offers competitive and attractive benefit packages for their employees. We strive to care for employees in positive ways that promotes wellness and productive employees.

Our first-class benefit package supports our employees and their dependents with:

Competitive pay structure and saving options that help you reach your financial goals
Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines!
Medical insurance offered with low-cost premium for employee only coverage and LIBERTY subsidizes 50% of dependent coverage for eligible enrolled dependents.
100% employer paid dental coverage for employees and eligible dependents.
100% employer paid vision coverage for employee only coverage, low-cost premium for dependents!
Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.
Long Term Disability coverage
Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.
Employee Assistance Program
Generous vacation and sick leave with the ability to roll time over.
10 paid company holidays
Tuition Reimbursement
Remote or Hybrid options for various positions
And so much more...

Compensation

In the spirit of pay transparency, we are excited to share the base hourly rate for this position is $25.00 - $30.00, exclusive of fringe benefits or potential bonuses. If you are hired at LIBERTY, your final base compensation will be determined based on factors such as geographic location, skills, education, and/or experience. In addition to those factors – we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.

LIBERTY Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. LIBERTY will leverage diverse perspectives in building high performance teams and organizational culture.

LIBERTY Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

LIBERTY Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.

LIBERTY Dental Plan jobs

Staff Dentist Contract Role WEST VIRGINIA

Staff Dentist Contract Role WEST VIRGINIA

Dental Case Manager LPN/LVN MUST RESIDE IN NEW JERSEY