Dental Case Manager
Location: Trenton, New Jersey
Description: Horizon Blue Cross Blue Shield of New Jersey is at present recruited Dental Case Manager right now, this position will be reside in New Jersey. Detailed specification about this position opportunity please give attention to these descriptions. This position is accountable for the management of common and routine dental cases, involving long term or catastrophic illness or injury in order to ensur! e cost and efficient utilization of benefits. The incumbent utilizing knowledge of community resources to promote the use of efficient and effective quality dental delivery of treatment and services.
Responsibilities:
Conducts high-level assessment and planning for selected population-based members to initiate and discontinue care management services in both inpatient and outpatient settings, in addition to catastrophic incidents.
Assess a patient's need for continued dental treatment and perform common and routine activities related to the management of long term illness or catastrophic cases through review of dental records, onsite visits and telephonic contact.
Negotiate fees for provider services on routine and specialty services for Par and Non Par Dental Providers.
Coordinates the delivery of high quality, cost-effective care based on a customized population model of care supported by dental clinical practice guidelines e! stablished by the plan.
Verifies member eligibility a! nd benefit plan, receive SPU (OR) requests, identify criteria, and generate authorizations for the dental healthcare provider.
Interacts with the member/family, Dental Provider and healthcare team. Utilizes the care management process to set priorities, plan, organize, and implement interventions that are goal directed toward self-care outcomes, and the transition to independent status.
Receives Special Needs referral request and assist in the facilitation of treatment planning cases for members with special needs and pediatric patients.
Documents accurately and comprehensively based on the standards of practice and current organization policies.
Coordinates and facilitate Special Needs Advisory Committee Meetings which is a contractually mandated meeting.
Generate monthly status reports contractually mandated.
Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to ! enhance member outcomes.
Performs other projects as assigned.
Compliance Statement::
Demonstrates knowledge and understanding of the laws, regulations and policies that pertain to the organizational unit's business and conforms with these laws, regulations and policies in carrying out the accountabilities of the job.
Education/Experience:
Prefers a Bachelor's degree from an accredited college or university in Dental Health Care Management, Sociology, and or Clinical Administration.
Requires a minimum of one (1) in the dental health care delivery system/industry.
Requires a minimum of two (2) years experience in managed care or pre-certification n the dental field.
Additional licensing, certifications, registrations:
Prefer a Dental Hygiene License
Require a valid NJ Driver License occasional travel to Nursing Home or other facilities required.
Knowledge:
Requi! res strong knowledge of dental healthcare delivery sytems/industry.
Prefers knowledge of healthcare contracts and benefit eligibility.
Requires knowledge of utilization management.
Requires excellent customer service skills.
Skills and Abilities:
Requires strong organizational skills.
Requires strong oral and written communication skills.
Requires the ability to prioritize and work in a high volume environment.
Requires good PC skills and the ability to utilize Mircrosoft Office applications (Excel, Access, Word, etc.)
Requires good problem solving and conflict resolution skills.
Travel (If Applicable):
Travel required as needed to do onsite assessments.
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If you were eligible to this position, please give us your resume, with salary requirements and a resume to Horizon Blue Cross Blue Shield of New Jersey.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position starts available on: Tue, 22 Oct 2013 19:40:27 GMT
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