Sr. Case Manager; Iowa

Overview

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Denta Quest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Location: Candidate must live in Iowa

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.

• 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.

• 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.
• Preferred License, Certification:
  Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Licensed Professional…