**Fast-paced and growing corporate office seeks a Case Manager, LVN.
The Case Manager is responsible for providing confidential, unbiased assistance to eligible LIBERTY Dental Plan (LIBERTY) enrollees of Florida Medicaid in need of dental services who also have a co-morbidity of special health care needs. Responsibilities include assisting the Coordinators Case Management (CCMs) to perform their professional functions.
- Inform enrollees of available covered dental benefits and assist in securing services.
- Help to resolve enrollee conflicts and barriers to dental care.
- Educate enrollees on their rights and responsibilities.
- Provide enrollees 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 calls and email inquiries regarding dental services, dissatisfaction, second opinions, etc.
- Provide education pertaining to the LIBERTY Care Coordination Program.
- Research and compose comprehensive written responses to all applicable inquiries.
- Review and edit, as applicable, all Florida Agency for Health Care Administration Provider Network Verification File responses prior to submission to LIBERTY Quality Management.
- Perform LIBERTY process for enrollees in need of hospital services for dental issues, and delegate to CCM, as applicable.
- Ensure dental case turnaround time is in accordance with access standards.
- Work collaboratively with enrollee's Medical Health Plan regarding medical and dental health needs.
- Ensure compliance to all regulatory guidelines.
- Review dental care plans every 6 months or sooner and ensure dental care plans are attached to enrollee HSP file.
- Participate in each Children’s Multidisciplinary Assessment Team meeting for LIBERTY Florida Medicaid enrollees, as applicable.
- Interface with Dental Offices, Primary Dental Providers, transportation vendors, hospital representatives, Florida Government Agencies, Foster, Medical Foster and Community-Based Service providers.
Education and/or Experience:
- Graduation from an accredited LVN program.
- Current valid license as a Licensed Vocational Nurse in accordance with State of Residency.
- Experience in and willingness to be part of a multi-disciplinary team.
- Preferred 1-3 years' experience as an LVN in public health, acute care, case management and/or in-home health care.
- 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.
- Must pass an assessment test.
- Bilingual English/Spanish preferred.
- 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.
Sponsorship and Relocation Specifications:
LIBERTY Dental Plan is an Equal Opportunity Employer.
No relocation assistance or sponsorship available at this time.