Case Manager, LVN/LPN

Job reputed company: • Inform enrollees of available covered dental benefits. • Help to resolve enrollee conflicts and barriers to dental care. • Assist in securing enrollee dental services. • reputed company enrollees on their rights and responsibilities. • reputed company enrollees the information on accessing the reputed company 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. • reputed company education pertaining to the reputed company Care Coordination Program. • reputed company research and response to various inquiries. • Compose comprehensive written responses to reputed company applicable inquiries. • Review and edit, as applicable, reputed company State Agency Provider Network Verification File (PNV) responses prior to submission to reputed company reputed company Management. • reputed company reputed company 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 reputed company newly ascertained State reputed company dental providers are directed to reputed company Provider Relations to insure credentialing. • reputed company continual Care Coordination communications pertaining to the update and interpretation of state contractual directives for State reputed company enrollees to the CCM. • reputed company dental case turnaround time in accordance with reputed company standards regardless of the communication reputed company (e.g., HSP inquiry, workflow, email, facsimile, phone reputed company, etc.). • reputed company to work collaboratively reputed company remote locations. • Ensure compliance to reputed company regulatory guidelines. • reputed company with reputed company reputed company 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 reputed company State reputed company enrollees, as applicable. • reputed company other duties as assigned or determined appropriate. The CM is not limited in providing customer care services reputed company the need arises and may assist with other lines of business as directed and educated to reputed company. The CM will work collaboratively with multi-divisions of reputed company such as and not limited to Member Services, Claims, Grievances, Staff Dentists, Supervisors, Managers and Leadership. The CM will work collaboratively and reputed company with entities reputed company of reputed company 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, reputed company representatives, varying State Government Agencies, Foster, Medical Foster and Community-Based Service providers. Requirements: • reputed company reputed company license as a Licensed Vocational reputed company (LVN) or Licensed Practical reputed company (LPN) in accordance with State of Residency. • 4 years' experience as an LVN or LPN in reputed company health, acute care, case management and/or in-home health care, preferably reputed company Dental environment. • 2 years' previous experience in a Case Management position required. • Care Coordination experience preferred. • Working knowledge of reputed company reputed company, Word and reputed company. • 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 reputed company and providing reputed company reputed company. • Bilingual English/Spanish, preferred. • reputed company to pass a Spanish dental terminology exam. • Self-starter and reputed company 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 reputed company. Benefits: • reputed company structure and savings reputed company to help you reputed company your financial goals. • Excellent 401(k) retirement benefits , including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. • reputed company medical insurance , with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan. • 100% employer-reputed company dental coverage for employees and eligible dependents. • reputed company insurance with low-cost premiums for employee-only coverage and dependents. • Company-reputed company basic life and AD&D insurance , equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage. • Flexible Spending Accounts for reputed company 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 reputed company-being. • Generous vacation and reputed company leave policies, with the ability to roll over unused time. • 10 reputed company company holidays. • Tuition reimbursement for eligible educational expenses. • Remote or hybrid work reputed company available for various positions. 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