Utilization Management Dental Hygienist

HumanaMansfield, TX
267d$65,000 - $88,600Remote

About The Position

Be a part of our caring community and help us put health first. The Utilization Management Dental Hygienist 2 evaluates the efficiency, appropriateness of dental treatments, services, procedures, and facilities provided to patients on a case by case basis. The Utilization Management Dental Hygienist 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This is a remote position. Core hours are Mon-Fri, 8am-5pm. This position will focus on evaluating appropriateness of dental treatments, dental claims, grievance & appeals as well as coordinating the processes between medical and dental utilization management. The Utilization Management Dental Hygienist 2 understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance when needed. Follows established guidelines/procedures.

Requirements

  • Associate/Bachelor's degree in Dental Hygiene.
  • Dental Hygiene (RDH) license with no disciplinary action.
  • Minimum 3 years of clinical experience.

Nice To Haves

  • Experience with, or knowledge of, Dental Benefits/Insurance.
  • Medicare experience.
  • Knowledge of CDT/CPT coding and billing.
  • Experience working with multiple technology platforms.

Responsibilities

  • Evaluate the efficiency and appropriateness of dental treatments and services.
  • Review dental claims, grievances, and appeals.
  • Coordinate processes between medical and dental utilization management.
  • Make independent determinations regarding appropriate courses of action.

Benefits

  • Benefits starting day 1 of employment.
  • Competitive 401k match.
  • Generous Paid Time Off accrual.
  • Tuition Reimbursement.
  • Parent Leave.
  • Go365 perks for well-being.

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What This Job Offers

Job Type

Full-time

Career Level

Mid Level

Industry

Insurance Carriers and Related Activities

Education Level

Associate degree

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