UnitedHealth Group Associate Dental Director, Clinical Quality of Care Dental Reviewer - US Telecommute in Miami, Mississippi
In collaboration with and under the supervision of the National Dental Director, the Associate Dental Director – Clinical Quality of Care, Dentist Reviewer is responsible for ongoing clinical review and determination of appeals and grievances cases for Dental Benefit Providers. Telecommute Role This role requires a License in 1 or 2 of the following States-New Hampshire, Mississippi, Florida or Hawaii Primary Responsibilities: Working as part of an integrated team of dental clinicians, and other members of the A&G staff Performing 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 of dental policies.
The Clinical grievances are related to the quality of care provided by contracted providers Communicating with other dental reviewers/directors regarding appeals and grievances for recommendation rationales and benefit interpretations Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results Providing clinical and strategic input when participating in organizational committees, projects, and task forces Required Qualifications: Current unrestricted Dentist Licensure with DDS / DMD 5+ years of clinical practice experience At least an intermediate level of proficiency with insurance and managed care Intermediate level writing skills Previous experience with quality of care reviews and standards Intermediate level presentation skills (for both clinical and non-clinical audiences) Familiarity with current dental issues and practices Basic computer skills – typing, word processing, presentation, and spreadsheet application skills, including internet researched skills Preferred Qualifications: Previous Quality Management experience Previous experience with claims coding and review Current licensure in the state of Florida, Hawaii, New Hampshire, and/or Mississippi Careers with UnitedHealthcare. Let's talk about opportunity.
Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution.
Now, add your energy, your passion for excellence, your near-obsession with driving change for the better.
Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe.
We bring them the resources of an industry leader and a commitment to improve their lives that's second to none.
This is no small opportunity.
It's where you can do your life's best work.SM *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace.
Candidates are required to pass a drug test before beginning employment. Job Keywords: dentist, claims review, quality, claims review, dental, DDS, appeals, Remote, telecommute, Telecommuter, Hawaii, Miami, FL, Tampa, FL, Florida, Chicago, IL, Illinois, Minneapolis, MN, Minnesota, New York, NY, New York db770954-d585-4581-b859-3d156820812d
Associate Dental Director, Clinical Quality of Care Dental Reviewer - US Telecommute Florida 762993