Case Manager, LVN Or LPN

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.

Applicants must have a current, valid LVN or LPN license in New York or New Jersey

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.