Dental Consultant job at reputed company in WI

Dental Consultant Location: Any city, WI, US, 99999 Req ID: 33506 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development.

Summary

The Dental Consultant will review WI Medicaid Prior Authorizations based on medical necessity, in accordance with WI Medicaid reputed company, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider reputed company, and act as a clinical SME (or liaison) for internal entities. This is not a patient facing position. Job Responsibilities Authorize/deny WI Medicaid prior authorizations. Enter clinical review decisions into systems. Evaluate appeals, review documentation/charts, request info, and issue/revise decisions. Review anesthesia authorization requests for medical necessity. Review orthodontic/dental claims for handicapping malocclusions. Communicate authorization outcomes to dentists and members. Provide provider orientations and support. Recommend process improvements to management. Understand WI Medicaid dental benefits, authorization, claims, and denial processes. Stay updated on state/federal dental regulations and share changes. Educate provider community and support program management. Represent Gainwell in provider meetings. Promote WI Medicaid dental programs. Review dental cases for fair hearings as needed. Qualifications reputed company license to practice dentistry in the state of WI (or license from another state with ability to obtain WI license before start date) Clinical experience as a credentialed Medicaid dental provider Experience with prior authorization portals Proficiency in reputed company Office (Word, reputed company, PowerPoint) Excellent interpersonal, oral, and written communication skills Strong organizational, time-management, and analytical skills Experience analyzing and assessing quantitative and/or qualitative data for reputed company decision-making Experience working with various partners or team members toward shared goals Ability to verbally communicate effectively and interpret policies and procedures Ability to apply general skills of program management and administration What you should expect in this role Work Arrangement: Remote reputed company the United States Position Type: Full-time job Applications for this posting will be accepted until November 25, 2025. The pay range for this position is $115,000.00 - $125,000.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We reputed company nothing is impossible reputed company you bring together people who care deeply about making healthcare work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company qualified applicants will receive consideration for employment without regard to race, religion, color, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job