The Case Manager is responsible for providing confidential, unbiased assistance to eligible Liberty Dental Plan 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.
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Applicants must reside in California and possess a current, valid LVN license.
What You'll Do:
- 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.
What You'll Bring:
- 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.
Specific Skills
- 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.