Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Clinical Review Dentist is a production role that supports the dental director on claims review. Solid knowledge of dental procedures, terminology and related dental codes along with solid computer and communication skills are crucial to this role.

*** Candidate must be available to work weekdays from 10:00 am - 7:00 pm CST and 8:00 am - 12:00 pm CST every other Saturday and Sunday. ***

Primary Responsibilities:

• Review of claims and supporting clinical data to provide accurate documentation for the dental director
• Accurate interpretation of radiographs, intra-oral photographs and clinical narratives
• Maintain organization and department defined standard of performance to meet metrics
• Communication with provider offices in accordance with compliance regulations to discuss adverse clinical determinations and to request missing information
• Independently manage individual queue assignments and workflow to meet deadlines, business needs and department and individual metrics
• Acts as a liaison between our dental directors and provider offices to maintain provider/member satisfaction
• Perform individual case review for appeals and grievances. The Appeals are in response to adverse determinations for dental services related to benefit design and coverage, medical necessity and the application of clinical criteria and dental policies, the Clinical Grievances are related to the quality of care provided by contracted dentists
• Participate in peer-to-peer calls with dental providers

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Dental degree from an Accredited Dental School
• Active and unrestricted dental license
• 7+ years of experience in clinical dentistry
• 3+ years dental benefit plan experience with specific exposure to claim review and utilization management or comparable experience.
• Ability to pass a credentialing review for practice experience
• Proficient in Microsoft Word, Excel and PowerPoint
• Excellent business analytical and writing skills

Preferred Qualifications:

• Active Dental License in Texas
• Experience with Dental Compliance related to Federal Regulations

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.