Senior Clinical Dental Consultant

November 6

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Description

• Review claims based on medical necessity. • Evaluate appeals. • Counsel providers and identify aberrant utilization patterns. • Authorize or deny claims, review authorization requests for anesthesia. • Communicate claim review outcomes to participating Dentists and Health Plans. • Develop knowledge of state and federal dental regulations. • Provide guidance on managing the dental program efficiently. • Establish relationships with dental associations and key stakeholders. • Recruit qualified providers for the network.

Requirements

• Graduate of an accredited Dental School (D.D.S. or D.M.D). • Orthodontic experience a plus. • Maintain an unrestricted dental license. • Knowledge of general dentistry. • Efficient PC skills. • Ability to use analytical/presentation tools such as Excel and PowerPoint. • Organizational and time management skills. • Ability to work with a team and independently. • Ability to make independent determinations on all types of dental claims. • Excellent written and verbal communication skills. • Ability to distinguish between multiple market benefits. • Ability to prioritize and organize multiple tasks. • Ability to remain organized with multiple interruptions. • Networking and Negotiation skills required. • Ability to travel as needed. • Required to attend additional training as requested/deemed necessary.

Benefits

• Excellent benefits and wellness programs to support your well-being – mental, physical and financial. • Generous vacation and sick time. • Market-leading paid family, parental and adoption leave. • Partially-paid sabbatical program. • Medical plans, company paid life, AD&D insurance, disability programs. • Retirement and Stock Purchase programs to help build future financial security including a 401(k) plan with an employer-paid match.