Sr. Case Manager, DentaQuest (California)

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.

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.

Job Description:

Location: Candidate must live in California

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

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.

How you will contribute:

• 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.

What you will bring with you:

• 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 Counselor (LPC/LPCC) or Registered Dental Hygienist (RDH),
• 1-3 years in case management, disease management or managed care preferred.
• Well-organized and exceptional 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.
• Self-motivated, and ability to work with little supervision.
• Strong problem-solving skills and the ability to make independent decisions.
• Knowledge of general computer software (Excel, MS Word, and Access a plus).
• Proven problem-solving skills.
  
  

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community (https://pages.beamery.com/sunlifecareers/page/join-us-canada) to stay connected until the time is right for you!

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.

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work® Certified in Canada and the U.S.
• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running
  
  

If you are a California resident, the salary range for this position is:

Southern California region: $84,100 - 126,200 annually

Northern California region: $89,800 - 134,700 annually

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

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. We’re proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "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 thebrightside@sunlife.com 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.

Job Category:

Health Advisor

Posting End Date:

29/04/2025