Case Manager, LVN/LPN

This is a fully remote position, open to applicants in New York.

📋 Description

• Offer confidential and impartial support to qualified Liberty Dental Plan State Medicaid enrollees with dental service requirements and associated health care conditions.

• Assist Care Coordinators in Care Management with their professional responsibilities.

• Educate enrollees regarding their covered dental benefits as well as their rights and responsibilities.

• Address enrollee disputes and obstacles related to accessing dental care.

• Secure dental services for enrollees.

• Clarify the processes for complaints, appeals, and grievances, including access to Liberty vehicles.

• Record cases and events in the Health Solutions Plus database.

• Handle telephone calls and email communications, including service requests, complaints, and second opinion inquiries.

• Provide information about the Liberty Care Coordination Program.

• Conduct research and respond to inquiries while creating detailed written replies.

• Review and refine responses for the State Agency Provider Network Verification File prior to submission to Quality Management.

• Manage enrollee requirements for hospital dental services and delegate to Care Coordinators when suitable.

• Direct newly identified State Medicaid dental providers to Provider Relations for credentialing.

• Relay updates and interpretations of state contractual directives to Care Coordinators.

• Complete dental case turnaround within access standards across all communication channels.

• Ensure adherence to regulatory, corporate, and departmental guidelines.

• Attach treatment plans, guardianship documents, and shelter orders to relevant enrollee files.

• Review dental care plans every six months or as per state contract requirements and attach them to enrollee files.

• Engage in multidisciplinary care team meetings.

• Collaborate with Liberty departments and external entities, including dental offices, providers, health plans, agencies, vendors, hospitals, physicians, legal representatives, and state agencies.

• Perform additional assigned tasks and support other lines of business as required.

⛳️ Requirements

• Active LVN or LPN license in accordance with state residency regulations.

• A minimum of 4 years' experience as an LVN or LPN in public health, acute care, case management, and/or in-home health care; dental experience is preferred.

• At least 2 years of prior experience in a Case Management role is mandatory.

• Experience in Care Coordination is preferred.

• Proficiency in Microsoft Excel, Word, and Outlook.

• Capable of crafting comprehensive written and verbal responses to inquiries.

• Strong critical thinking skills for resolving inquiries and escalated cases while orchestrating holistic care.

• Background in conflict resolution and one-call resolution is preferred.

• Bilingual in English and Spanish is preferred.

• Ability to pass a Spanish dental terminology examination.

• Self-motivated and a team player with excellent organizational skills.

• High level of patience and outstanding communication and interpersonal abilities.

• Exceptional customer service skills.

• Capability to work independently or collaboratively within a team.

• Must be eligible to work in the United States.

• No sponsorship or relocation assistance is available.

🏝️ Benefits

• Competitive pay structure and savings options.

• 401(k) retirement benefits with employer matching, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Affordable medical insurance with low-cost premiums for employee-only coverage; Liberty subsidizes coverage for eligible dependents.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance.

• Company-paid basic life and AD&D insurance equal to one times base salary, with options for supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Wellness programs, including wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program supporting mental health and well-being.

• Generous vacation and sick leave policies, including unused-time rollover.

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Remote or hybrid work options available for various positions.