Dental Clinical Review Director - 671217
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
Position will manage the Dental Utilization Review (UR) and Prior Authorization (PA) programs and support the Fraud, Waste and Abuse (FWA) program; lead the remediation of providers under investigation; provide clinical expertise in the areas of UR, FWA, payment integrity (PI) and the clinical aspects of benefit design; respond to RFPs and be the clinical liaison to internal and external entities related to UR, PA, PI and FWA.
- Manage Utilization Review and Prior Authorization Programs
- Provide clinical support to the Fraud & Abuse and Payment Integrity Programs
- Serve as the primary clinical liaison to external UR vendors
- Oversee internal and external dental consultants and related staff, including training and development and Inter-rater Reliability
- Identify providers with aberrant utilization patterns and support the Fraud/Abuse investigation process including auditing providers, generating reports, correspondence and provider outreach and remediation
- Develop policies and procedures related to Utilization Review, Prior Authorization and Fraud/Abuse
- Counsel participating and non-participating dentists with aberrant utilization patterns
- Interface with external entities including UR Vendors, OptumInsight, regulatory agencies as required to support the UR, PA and FWA programs
- Respond to RFPs related to UR, PA, FWA and the clinical aspects of payment integrity
REQUIREMENTS: To be considered for this position, applicants need to meet the qualifications listed in this posting.Required Qualifications:
- Undergraduate degree or equivalent experience.
- Dental degree
- Active dental license in at least one state
- 5+ years dental managed care and supervisory experience with specific exposure to claim review and utilization management with demonstrated medical cost control results
- Comprehensive knowledge of Utilization Review
- Experience with Fraud, Waste and Abuse investigations
- Strong PC skills including PowerPoint, Excel and Access
- Excellent analytical and writing skills
For consideration, please email your CV or resume to firstname.lastname@example.org.
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)
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.
Sorry,this is NOT an opportunity for Search Firm recruiters.