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Dental Physician Reviewer

2 months ago

Arkansas City, United States Acentra Health Full time

CNSI, Kepro, and Espyr are now Acentra Health Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company's mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes, making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

The Dental Physician Reviewer will oversee utilization /management (UM) activities to include peer review, utilization review, fair hearings and appeals, and other clinical consultations related to the applicable contract. The Dental Physician Reviewer will support the Dental UM contract for Arkansas.

  • Responsible for the clinical oversight of the Dental Utilization Management program.
  • Collaborate with Medical Director on case consultations as needed.
  • Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management Dental Hygienist Reviewers.
  • Participate in the client's quarterly and ad-hoc contract meetings.
  • Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.
  • Complete all secondary-level Dental Utilization Management reviews.
  • Develop and complete an annual review of clinical medical necessity criteria.
  • Travel as needed for client-requested meetings or in-services (minimal travel required).
  • Perform any other duties assigned.
  • Participate in appeal hearings as needed.
Requirements
  • DMD or DDS from accredited dental school.
  • Must have AR license and DEA.
  • 10+ years of clinical practice preferred.
  • 5-7 years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.
  • Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
Additional Requirements:
  • Proficient in Microsoft Excel and other Microsoft Office applications.
  • Exceptional writing and oral communication abilities.
  • Maintain a professional manner and demeanor.
  • Able to collaborate effectively with team members and thrive in a collaborative work environment.
  • Strong knowledge of quality assurance and utilization review.
  • Understand significant trends in healthcare and managed care.
  • Ability to work effectively with a diversity of personalities.
  • Ability to be approachable, show respect for others and be a consensus builder.
  • Strong organizational skills and a system thinking approach.
  • Ability to efficiently manage projects.
  • Ability to deliver on time and within budget.
  • Adaptable with a collaborative solid management style.
  • Ability to be a creative thinker.
  • Possess high energy and enthusiasm.
  • Able to adapt to frequently changing work parameters.
Preferred qualification:
  • Prior review experience or quality assurance committee responsibility preferred.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career.

Thank You

We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.