Oral Surgeon

3 weeks ago


Little Rock, Arkansas, United States CNSI Full time
Job Summary:

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

Key Responsibilities:
  • Collaborate with Medical Director and other Dental Physician Reviewers on case consultations as needed.
  • Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management Dental Hygienist Reviewers.
  • Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.
  • Complete all secondary-level Dental/Oral Surgeon Utilization Management reviews.
  • Develop and complete an annual review of clinical medical necessity criteria.
  • Travel in-state as needed for client-requested meetings or in-services (minimal travel required).
  • Perform any other duties assigned.
Requirements:
  • DMD or DDS from accredited dental school.
  • Completion of an accredited US Oral Surgery Residency Program.
  • Active Arkansas dental license.
  • 10+ years of clinical practice preferred.
  • Experience in Utilization Management, Case and Disease Management with knowledge of Medicaid and Medicare programs.
  • Prior review experience or quality assurance committee responsibility preferred.
Additional Qualifications:
  • 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.
  • Ability to work remotely.
  • 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 deliver on time and within budget.
  • Ability to be a creative thinker.
  • Possess high energy and enthusiasm.
  • Able to adapt to frequently changing work parameters.

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