Oral Surgeon

3 weeks ago

Hattiesburg, Mississippi, United States Acentra Health Full time
Job Summary:

Acentra Health is seeking an experienced Oral Surgeon to join our team as a Utilization Reviewer. In this role, you will oversee utilization review/management activities, including peer review, utilization review, fair hearings, and appeals, and other clinical consultations related to the applicable contract.

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).
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.

  • Oral Surgeon Reviewer

    4 weeks ago

    Hattiesburg, Mississippi, United States Acentra Health Full time

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