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About the Role

The Case Manager provides confidential, unbiased assistance to eligible Liberty Dental Plan enrollees of State Medicaid programs who have special healthcare needs and require dental services. This role also involves assisting Care Management Coordinators (CCMs) in their professional functions.

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 information on accessing Liberty's complaint, appeal, or grievance process.
Ensure enrollee cases and events are documented correctly in the Health Solutions Plus (HSP) database.
Manage telephone calls and email inquiries regarding dental services, dissatisfaction, and second opinions.
Provide education pertaining to the Liberty Care Coordination Program.
Conduct research and respond to various inquiries.
Compose comprehensive written responses to all applicable inquiries.
Review and edit State Agency Provider Network Verification File (PNV) responses prior to submission to Liberty Quality Management.
Perform Liberty process for enrollees needing hospital services for dental issues and delegate to CCMs when appropriate.
Ensure newly ascertained State Medicaid dental providers are directed to Liberty Provider Relations for credentialing.
Provide continual Care Coordination communications regarding updates 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 communication route.
Ensure compliance to all regulatory guidelines.
Comply with all Liberty corporate and department guidelines, policies, and procedures.
Ensure treatment plans and guardianship documents are attached to applicable enrollee HSP files, including shelter orders for foster and Medical Foster Enrollees.
Review dental care plans every six months or per State contract requirement and ensure they are attached to enrollee HSP files.
Participate in Multidisciplinary Care Team meetings for Liberty State Medicaid enrollees, as applicable.
Perform other duties as assigned or determined appropriate.
Provide customer care services and assist with other lines of business as directed.
Work collaboratively with multi-divisions of Liberty and external entities such as Dental Offices, health plan Care Coordinators, hospitals, and State Government Agencies.

Requirements

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

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.
High degree of patience.
Excellent communication and interpersonal skills.
Excellent customer service skills.
Ability to work independently or in a team.
Able to work collaboratively within remote locations.

Location

New York - NY

Work Type

Full Time
Remote or hybrid work options available

Experience Level

4 years' experience as an LVN or LPN
2 years' previous experience in a Case Management position

Education Level

Current valid license as a Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)

Salary/Compensations

$29.00 - $35.00/hourly

Benefits

Competitive pay structure and savings options.
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice.
Affordable medical insurance, with low-cost premiums for employee-only coverage and Liberty subsidizing the cost for eligible dependents.
100% employer-paid dental coverage for employees and eligible dependents.
Vision insurance with low-cost premiums.
Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
Flexible Spending Accounts for healthcare and dependent care expenses.
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
Long-term disability coverage.
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
Employee Assistance Program (EAP) to support mental health and well-being.
Generous vacation and sick leave policies, with the ability to roll over unused time.
10 paid company holidays.
Tuition reimbursement for eligible educational expenses.

About the Company

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.

Equal Opportunity

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.
Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.