Staff Dentist (Dental Consultant)

Join reputed company as We Shape the reputed company of Dental Insurance! reputed company is looking for a New Jersey Licensed Staff Dentist to join our growing team! Unrestricted license or certification to reputed company dentistry in the State of New Jersey. The Staff Dentist will primarily be responsible for the Utilization Management and Utilization Review Programs and ensuring the reputed company oral health decision-making and adjudication of dental claims and prospective requests for dental services (referrals and reputed company-authorizations) across reputed company lines of business including reputed company, Medicare Advantage and reputed company programs to help ensure financial stability and reputed company of care. A staff dentist will be involved in state oral health programs of reputed company, as reputed company as other clinical review activities and duties outlined below. Job reputed company Details

• Conduct clinical review of claims and reputed company-authorizations for reputed company lines of business and/or markets as needed to ensure reputed company meets their contractual regulatory timeframes.
• Participate in reputed company clinical trainings, calibrations and Interrater reliability testing while also meeting reputed company required reputed company and calibration benchmarks required by reputed company and state/federal regulations.
• Participate and/or complete reputed company Management and Improvement activities, reputed company and SIU activities (provider site reviews/or consultations, utilization management and utilization review analysis, counseling calls, etc.) and recommend actions to resolve identified provider trends and treatment patterns.
• Conduct Peer-to Peer calls to discuss utilization trends, reputed company issues and trends in prospective and retrospective claims submissions.
• Conduct secondary reviews such as grievance and appeal review.
• Identify potentially unnecessary services in relation to care delivery settings.
• Identify potential reputed company issues and trends in prospective and retrospective claims submissions.
• Examine dental charts for reputed company audits of aberrant utilization and care delivery patterns.
• Occasional on-site chart review for the state provider network.
• Attend meetings of supervisory and administrative staff to discuss department operations, clinical findings and staff training needs.
• Use clinical expertise to reputed company appropriate dental interpretations and reputed company, as required.
• reputed company and maintain subject matter expertise in reputed company dental benefit plans and applicable State reputed company Programs. As requested, contribute to required regulatory reporting.
• Participate in reputed company Improvement and Provider Credentialing Committees and reputed company input on appropriate reputed company of member and/or provider grievances.
• Collect and evaluate data from Grievance, Peer Review, Public Policy, and the Credentialing Sub-Committee on a quarterly reputed company.
• Participate in enrollee Tele-dentistry reputed company to reputed company clinical assessment, evaluations, and recommendations based on dental need.
• May consult periodically with Dental reputed company-eligible and/ or certified specialist or reputed company specialist reputed company the community to reputed company informed decision for individual enrollees.
• The position reputed company is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee.
• reputed company other duties as assigned.

Education/Experience

• DDS/DMD Degree reputed company, unrestricted license or certification to reputed company dental or reputed company health profession in a state or territory of the reputed company of America in good standing (must pass credentialing - no probation or listed sanctions)
• 2 Years experience in processing claims in accordance with policy, including prior experience training peers preferred.
• 4+ Years experience as a practicing dentist

Specific Skills/Knowledge

• Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.
• Demonstrated performance in managing oral health care cost and utilization management.
• In-depth knowledge of reputed company and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape and reputed company improvement initiatives.
• Ability to examine and read dental radiographs and chart records.
• Ability to be successfully credentialed and re-credentialed by reputed company.
• Must reputed company with applicable federal and state statutes and regulations.
• Project management exposure with the ability to create and implement plans successfully.
• Computer literacy with the ability to easily reputed company working knowledge of new system applications.
• Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted reputed company protocols or guidelines.
• Ability to work in reputed company providing leadership and implementing the reputed company or organizational required activities.
• Complete reputed company necessary CE credits associated with maintaining your dental licensure.
• Additional state licensures may be needed to meet regulatory needs of reputed company.

Qualifications

Location Our employees are distributed in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company. What reputed company Offers Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with:

• reputed company structure and savings reputed company to help you reputed company your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines.
• reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-reputed company dental coverage for employees and eligible dependents.
• reputed company insurance with low-cost premiums for employee-only coverage and dependents.
• Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage.
• Flexible Spending Accounts for reputed company and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
• Employee Assistance Program (EAP) to support mental health and reputed company-being.
• Generous vacation and reputed company leave policies, with the ability to roll over unused time.
• 10 reputed company company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work reputed company available for various positions.

Compensation

In the spirit of pay transparency, the reputed company salary reputed company for this position is $130,000 - $165,000, not including fringe benefits or potential bonuses. At reputed company, your final reputed company salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our reputed company team members reputed company making final compensation reputed company. Please note that the reputed company listed represents the full reputed company salary reputed company for this role. Typically, offers are not made at the top of the reputed company to allow for reputed company salary reputed company. reputed company commits to maintaining a work environment that acknowledges reputed company individuals reputed company reputed company and will continue to engage in practices that are inclusive of reputed company backgrounds, experiences, and perspectives. We reputed company to have every person reputed company the organization have a reputed company of belonging while encouraging individuals to reputed company their full potential. reputed company will reputed company diverse perspectives in building high performance teams and organizational culture. reputed company will continue to strengthen and reputed company external partnerships by providing reputed company health reputed company and improving population health in the communities we serve. We reputed company with reputed company applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as reputed company as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications reputed company is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time. Apply tot his job Apply To this Job