Clinical Review Dentist

Improve the lives of others while Caring. Connecting. Growing together. Job Description – Clinical Review Dentist (2346754) Clinical Review Dentist – 2346754 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. Solid knowledge of dental procedures, terminology and related dental codes along with solid computer and communication skills are crucial to this role. Candidate must be available to work weekdays from 10:00 am – 7:00 pm CST and 8:00 am – 12:00 pm CST every other Saturday and Sunday. Primary 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 You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications Dental degree from an Accredited Dental School Active and unrestricted dental license 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 Preferred Qualifications Active Dental License in Texas Experience with Dental Compliance related to Federal Regulations Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far‑reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full‑time employment. We comply with all minimum wage laws as applicable. Equal Employment Opportunity Statement UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call View phone number on click.appcast.io to be connected to Recruitment Services. UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr