Clinical Review Dentist - PST time zone

UnitedHealth Group•Cypress, CA

17h•Remote

About The Position

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. 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.

Requirements

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

Nice To Haves

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

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