[Hiring] Clinical Review Dentist @UnitedHealth Group

Role Description

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

Candidate must be available to work weekdays from 8:00 am – 5:00 pm PST and 8:00 am – 12:00 pm PST 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 related to adverse determinations for dental services.
• Participate in peer-to-peer calls with dental providers.

Qualifications

• Dental degree from an Accredited Dental School.
• Active and unrestricted dental license for the state of California.
• 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.

Requirements

• Active Dental License in Texas (preferred).
• Experience with Dental Compliance related to Federal Regulations (preferred).
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Salary range from $112,700 to $193,200 annually based on full-time employment.

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.