[Hiring] Clinical Reviewer, Dental Hygienist @Devoted Health

Role Description

A licensed dental hygienist will play a vital role within Devoted Health's Clinical Operations team by performing first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority. This position ensures accurate, timely, and compliant utilization management while supporting high-quality, compassionate care and strong relationships with dental providers.

Schedule: The position follows a five-day, eight-hour work schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET and will include weekend and Holiday rotation coverage.

Your Responsibilities and Impact will include:

• First-Level Clinical Evaluation: Review assigned dental claims and pre-treatment estimates requiring clinical evaluation, approving claims that meet clinical, contractual, and documentation requirements.
• Documentation & Image Review: Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise.
• Case Referral & Coordination: Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination (the Dental Hygienist Clinical Reviewer does not deny authorizations).
• Documentation & System Entry: Identify required documentation for clinical review, clear processing instructions, and document review findings accurately in claims systems.
• Coding & Policy Application: Consistently apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions.
• Quality & Escalation: Identify and escalate unusual practice patterns, utilization trends, potential fraud, waste, or abuse concerns, policy gaps, or workflow issues.
• Cross-Functional Collaboration: Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support smooth operations and constructive provider communications.
• Compliance: Maintain full compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements.

Qualifications

• 5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting. Dental claims review or utilization management experience is a plus.
• Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing.
• Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation.
• Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records.
• Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail.
• Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools.
• Experience with technology-enabled workflow improvements, particularly with AI/LLM tools.

Requirements

• Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting.

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....