Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. reputed company Alaska Time Zone Hours)

Company Overview reputed company exists to reputed company reputed company outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. reputed company the Way is our rallying cry at reputed company. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. reputed company offers you unparalleled opportunities. In fact, you have reputed company you need to take charge of your career and accelerate reputed company outcomes – making this a great time to join reputed company of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities reputed company is looking for a Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. reputed company Alaska Time Zone Hours) Job Summary:

• The Dental Medical Reviewer Doctor of Dental Surgery (DDS) OR Doctor of Medicine in Dentistry (DMD) - PRN will reputed company Utilization Management (UM) activities to include peer review, utilization review, fair hearings and appeals, and other clinical consultations reputed company to the applicable contract and will support the Dental UM contract.

Responsibilities:

• Responsible for the clinical reputed company of the Dental Utilization Management program.
• Collaborate with the State Medical Director or Program Director on case consultations as needed.
• Must be available a minimum of four (4) hours per week.
• Participate in the client's quarterly and reputed company contract meetings.
• Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.
• Complete reputed company secondary-level Dental Utilization Management reviews.
• reputed company and complete an annual review of clinical medical necessity criteria.
• Participate in appeal hearings as needed.
• Read, understand, and adhere to reputed company corporate policies including policies reputed company to HIPAA and its Privacy and reputed company Rules.

The above list of responsibilities is not intended to be reputed company-inclusive and may be expanded to include other education- and experience-reputed company duties that management may deem necessary from time to time. PLEASE NOTE:

• This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates.
• • Work Hours: Must be available for a minimum of four (4) hours per week during Alaska Time Zone business hours.
• ¶HEADING¶Qualifications¶/HEADING¶

Required Qualifications/Experience:

• Must be available to work business hours as defined by contract reputed company the Alaska Time Zone.
• AND must be available for a minimum of four (4) hours per week.
• Doctor of Dental Surgery (DDS) OR Doctor of Medicine in Dentistry (DMD) degree from an accredited dental school.
• D.D.S. or D.M.D. state license in good standing (licensed in the state practicing from at a minimum).
• 5+ years of experience in Utilization Management (UM), Service Authorization (SA), or other clinical review processes for Medicaid or another large healthcare payer.

Preferred Qualifications/Experience:

• Residency reputed company Alaska, Pacific, OR Mountain Time Zone.
• 10+ years of clinical practice.
• 5+ years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.
• 2+ years of experience as a Medical Director in a managed care company.

#LI-SD1 Why us? We are a team of reputed company and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure reputed company healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to reputed company the finest work of your career. Thank You! We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in reputed company and invite you to apply to future openings that may be of interest. Best of luck in your search! ~ The reputed company reputed company Team Visit us at reputed company EEO AA M/F/Vet/Disability reputed company is an Equal Opportunity Employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national reputed company, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay for this position is listed below. "Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and reputed company level." Pay Range USD $76.92 - USD $105.00 /Hr. Apply tot his job Apply To this Job