Dental Case Manager

Dental Case Manager

Requirements

• Position requires a bachelor’s degree in business administration, healthcare administration, or a related field
• Three years of experience as a dental hygienist, community health worker, dental assistant or dental office support staff, or counseling or educating individual patients and/or the general public regarding the importance of good oral hygiene habits, conducting dental research or data collection and analysis, or designing or administering a public health program or dental education program
• Advanced knowledge of dental terminology, dental procedure codes, appropriate dental care, and the claims adjudication process
• Care coordination planning, implementation, analysis and reporting skills
• Strong analytical skills
• Knowledge of word processing, spreadsheet, and database applications
• Strong verbal and written communication skills
• Ability to represent and present on behalf of the organization, both internally and externally
• Ability to work independently and as part of a team
• Ability to manage multiple projects with competing deadlines
• Ability to resolve complex problems and use independent judgment
• Position requires travel of 50-75% throughout the state of Tennessee, and nationally as necessary

Responsibilities

• Coordinates with dental providers, insurance companies, and other healthcare professionals to facilitate patient care
• Establishes policies and procedures for effective case management and ensures all activities comply with federal and state Medicaid guidelines
• Monitors program performance and adjusts strategy to enhance efficiency and outcomes, ensuring continuous quality improvement
• Monitors patient progress and adjusts care plans as necessary, following up with providers on prior authorizations and treatment plans, and ensuring claim payment for both in-network and out-of-network providers, as necessary
• Facilitates communication between patients, dental providers, managed care organizations and other healthcare professionals to ensure continuity of care, benefit utilization and follow-up after treatment is complete
• Ensures compliance with healthcare regulations and standards for HIPAA, exchange of PHI, and information security
• Provides direct education and support to members to help them understand and navigate their dental benefits
• Analyzes case management data to identify trends, outcomes, and areas for improvement
• Oversees the development and distribution of educational materials and other communications to members and dental provider offices
• Represents the Dental Case Management team with various external stakeholders and contacts, including state administrators, health plans/managed care organizations, community-based organizations, dental schools, dental hygiene schools and other dental workforce training programs, primary care associations, dental professional associations, and others
• Attends external, community facing or other stakeholder events in accordance with contractual responsibilities, in facilitation of increased utilization, at the request of community partners or managed care organizations, and in support of the clinical goals for the Medicaid program
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above

Preferred Qualifications

• Previous experience in insurance, a state Medicaid program, a dental office setting, clinical dental and/or public health or as a care coordinator/case manager is also preferred