Sr. Case Manager, DentaQuest (Iowa)

Sun Life•Des Moines, IA

16d

About The Position

The Sr. Case Manager works with members requiring intensive or complex care, to assess, facilitate, plan and coordinate integrated care across the dental and medical care delivery systems. This role will develop and implement an individualized care plan in collaboration with the member/member’s support network to address the member’s needs and reach established goals. The Sr. Case Manager works to ensure the member is making progress toward desired outcomes.

Requirements

Bachelor’s Degree in a health-related field, 3 years clinical experience or any combination of education an experience which would provide an equivalent background.
Well-organized and exceptional organizational, written and oral communication skills, particularly presentation skills.
Knowledge of clinical and industry terminology and procedures.
Self-motivated, and ability to work with little supervision.
Strong problem-solving skills and the ability to make independent decisions.
Knowledge of general computer software (Excel, MS Word, and Access a plus).
Proven problem-solving skills.

Nice To Haves

Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Licensed Professional Counselor (LPC/LPCC) or Registered Dental Hygienist (RDH), 1-3 years in case management, disease management or managed care preferred.
Knowledge of quality improvement methodologies and population health management preferred.
Knowledge of healthcare advocacy activities is preferred.

Responsibilities

Completes comprehensive assessments of members according to timelines defined in policy to identify members eligible for case management based on stratification criteria, scoring, clinical judgment, and triggers identified during the assessment.
Develops and implements an individualized care plan in collaboration with the member, caregiver, Managed Care Organization, provider, community-based organization and/or the members support network.
Deliver evidence-based, enrollee-centered interventions and follow-up that facilitates the delivery of needed preventive and treatment services, promote self-management and connect members to needed social aids
Ensure appropriate and timely access to quality care through coordinating services needed and eliminating barriers to receiving care.
Partner with other entities involved in member’s care, including medical and dental providers, Managed Care Organization, and community-based organizations, in a coordinated approach that promotes oral and systemic health and creates new lines of communication to addresses both the medical and dental needs of the member.
Performs ongoing monitoring of the care plan to evaluate effectiveness, document interventions, identify variances and progress to goal achievement.
Implements necessary changes and/or corrective actions to address variances, changes in circumstances or other variables that are impeding progress toward achieving goals.
Maintains ongoing member case load for regular outreach and management.
Applies fundamentals of self-management and motivational interviewing techniques to set goals, educate, support and motivate behavioral change.
Facilitate collaborative activities with Managed Care Organizations to promote care continuity and bridge the gap between medical and dental health of members.
Compile information and reports to produce metrics and case management program evaluation
Identify, create and improve workflows in case management program and interdisciplinary team to ensure optimum support assisting members in navigating medical and dental care delivery system.
Represent the company in a professional manner at all times.
Completes special projects as requested.
Adhere to business processes.
Other duties as assigned.

Benefits

generous vacation and sick time
market-leading paid family, parental and adoption leave
medical coverage
company paid life and AD&D insurance
disability programs
partially paid sabbatical program
401(k) employer match
stock purchase options
employer-funded retirement account
flexible, inclusive and collaborative work environment that supports career growth