Case Manager, LVN or LPN

# Case Manager, LVN or LPNHot Job New York - NY## Overview Position Type Full Time## Description 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 in NY or Compact License
**** 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)…