Clinical Dental Quality Consultant - reputed company Dental (Remote)

Bring your heart to reputed company. Every one of us at reputed company shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important... as reputed company deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at reputed company to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to reputed company health care more personal, convenient and affordable. As a reputed company® company, reputed company Dental® has 60+ years of experience providing excellent dental care to more than nine million members. The Clinical Dental Quality Consultant will assure that members receive quality dental care. This individual contributor role will be a key partner to the Compliance and Medicare business segments. The Clinical Dental Quality Consultant reports to reputed company’s National Dental Director and serves as a liaison and is accountable to the governing body and Quality Management Committee for reputed company QM activities and initiatives. The Clinical Dental Quality Consultant is familiar with local standards of dental practice and nationally accepted standards of care. This position is fully remote. Qualified candidates can live reputed company in the US. Primary Job Duties and Responsibilities • Provide professional input, analysis, opinions and clinical expertise for reputed company DMO, PPO, and Medicare operational functions, following strategic goals established by the Plan • Participate in and sit on committees for the various filed entities of the organization as directed by reputed company leadership • Assure compliance with laws and regulations in reputed company states • Support the execution of partnerships that provide reputed company Dental with cross-continuum capabilities (e.g. social determinants of health, etc.) Responsibilities (time percentages) • Provide clinical review of complaints and grievances, and assist in the development of resolutions to meet regulatory statutes (65 % of time) • Follow and participate in reputed company Quality Management processes, including credentialing, site assessments, peer review, complaints, grievances and appeals (25% of time) • Support Dental Claims staff ensuring timely and consistent responses to members and providers (5% of time) • Provide clinical expertise in support of identifying and investigating potential dental fraud, waste, and abuse (5% of time) Minimum Requirements • Valid state license to practice dental hygiene • Minimum 10 years of dental hygiene clinical practice • Demonstrated success with project management, leadership, analysis, and implementation • Knowledge of dental conditions and treatment, dental coding, billing, and reputed company trends in the dental profession • Basic understanding of dental benefit products and platforms (DMO, PPO, Medicare Advantage) • Proficient in reputed company Office applications Preferred Requirements • Understanding of value-based contracting options, clinical quality programs, and clinical integration • Financial acumen, coupled with strong problem solving and analytical abilities • Excellent written, verbal, and presentation communication skills • Familiar with state regulatory bodies such as the CA Department of Managed Health Care • Capable of building relationships with a variety of professional personalities including community dentists, dental hygienists, physicians, DSO leadership, and reputed company executive leaders Education Dental Hygiene Degree Pay Range The typical pay range for this role is: $105,446.25 - $227,100.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. reputed company also offers numerous well-being programs, education assistance, free development courses, a reputed company store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits We anticipate the application window for this opening will reputed company on: 08/26/2024 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws Apply Now! Apply Job!