10 days old

Case Manager (Louisiana Based Candidates Preferred)

New Orleans, LA 70112
  • Job Code

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it.

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and deliveringmeasurableoutcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

The 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. The case manager will develop and implement an individualized care plan in collaboration with the member/members support network to address the members needs and reach established goals. The case manager works to ensure the member is making progress toward desired outcomes.

Completes comprehensive assessments of members according to timelines defined in policy to determine 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 supports.
Ensure appropriate and timely access to quality care through coordinating services needed and eliminating barriers to receiving care.
Partner with other entities involved in members 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 principles 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 DentaQuest in a professional manner at all times.
Completes special projects as requested.
Adhere to DentaQuest business processes.

Bachelors Degree in Business, Healthcare Administration (or related field) or equivalent, relevant work experience.
Three years clinical experience or any combination of education and experience which would provide an equivalent background.
One year of experience in case management, disease management or managed care preferred.
Well-organized and superior organizational, written and oral communication skills, particularly presentation skills.
Knowledge of quality improvement methodologies and population health management preferred.
Knowledge of healthcare advocacy activities is preferred.
Knowledge of clinical and industry terminology and procedures.
Strong written and oral communication skills.
Proficient with general computer software including Microsoft Excel, Word and Outlook.
Proven problem-solving skills.

Ability to make good judgment conclusions based on data available with minimal supervision.
Ability to prioritize and organize multiple tasks with tight deadlines.
Ability to work in a traditional professional office setting or remote equivalent.
Work schedule may vary and is determined by project schedules.
Ability to travel as projects dictate.
Ability to efficiently operate all job-related office equipment.
Ability to work in a dynamic environment.

Posted: 2021-01-05 Expires: 2021-02-03
Sponsored by:
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Sponsored by:
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Case Manager (Louisiana Based Candidates Preferred)

New Orleans, LA 70112

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