Sr. Care Coordinator, DentaQuest

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 6400 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.

DentaQuest 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.

How you will contribute:

• Intensive Needs Care Coordination as required by contract with Coordinated Care Organizations (CCOs) and the Oregon Health Authority (OHA) providing targeting services to members with special physical mental environmental or age-related needs
• Research and resolve all Case Management requests received from the Provider Network in regard to behavior fraudulent or special healthcare needs that cannot be met in the office setting
• Out of Network service arrangements with out of network providers based on organizations policies
• In Area Out of Network service arrangements with local out of network providers in order to provide local specialized treatment where needed based on organizations policies
• Coordinate with CCOs Resource Parents and providers to ensure all DHS Foster children are seen in a timely manner.
• Processing of items needing additional coordination such as:
• o Member request for assistance through a Health Risk Screening
• o Processing of Second Opinion requests from members
• o Processing of Tribal Health Referrals
• o Processing Permanent Referral Requests from PCDs
• Assist with care coordination of members with special health care needs as designated by CCO OHA members members caregiver or representative. This includes but is not limited to:
• o Engaging foster parents in assessments for members in foster care as reported by the CCO
• o Initiating care for members that are indicated as residing in care facilities or those with social determinants of health (SDoH) as indicated by the CCO
• Ensure all documentation is entered accurately and timely into all case management systems for continuity of care purposes
• Assist in improving the regions health by considering each community members unique health cultural and social needs
• Other duties as needed or required.

What you will bring with you:

• High school diploma or equivalent
• 2 years of experience working with Medicaid populations by phone or in person; knowledge of Oregon Medicaid highly preferred
• 6months of experience working in an entry level Care Coordinator or Case Manager position (or equivalent)
• Experience with trauma informed care preferred
• Computer proficiency in a variety of Windows applications
• Attends additional training as requested/deemed necessary

Preferred:

• Certification as a Community Health Worker or other Traditional Health Worker designation
• Associates or Bachelors Degree in Social Work
• Experience in a dental/medical insurance setting

Physical Demands:

• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute).
• Ability to travel or move about within and outside serviced facilities required.
• Incumbent works primarily in either a private or shared office environment.

Salary: $54000 - 72900
At our company we are committed to pay transparency and equity. The salary range for this role is competitive nationwide and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills qualifications experience education and geographic addition to your base salary this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong are supported and empowered to thrive. We are dedicated to building teams with varied experiences backgrounds perspectives and ideas that benefit our colleagues clients and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life we prioritize your well-being with comprehensive benefits including generous vacation and sick time market-leading paid family parental and adoption leave medical coverage company paid life and AD&D insurance disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match stock purchase options and an employer-funded retirement account. Enjoy a flexible inclusive and collaborative work environment that supports career growth. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.

For applicants residing in California please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of applicable state and local laws including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.