Current jobs related to Dental Utilization Manager - Charleston, West Virginia - LIBERTY Dental Plan

  • Dental Hygienist

    5 days ago

    Charleston, West Virginia, United States Aspen Dental Full time

    At Aspen Dental, we prioritize patient care and well-being by providing a supportive environment for our dental hygienists to excel in their roles. As a Dental Hygienist, you will be a key partner in developing patient care plans, utilizing the American Academy of Periodontology (AAP) guidelines. Your schedule will be managed to allow for comprehensive...

  • Dental Hygienist

    2 weeks ago

    Charleston, West Virginia, United States Aspen Dental Full time

    Aspen Dental Hygienist Job SummaryWe are seeking a skilled Dental Hygienist to join our team at Aspen Dental. As a Dental Hygienist, you will play a vital role in providing exceptional patient care and contributing to the success of our dental support organization.Key Responsibilities:Travel to nearby offices to support practice operationsDevelop patient...

  • Utilization Management Nurse

    4 weeks ago

    Charleston, West Virginia, United States MUSC Health & Medical University of SC Full time

    Job SummaryWe are seeking a skilled Utilization Management Nurse to join our team at MUSC Health & Medical University of SC. As a key member of our healthcare team, you will play a vital role in ensuring that patients receive the most appropriate care for their condition.Key ResponsibilitiesConduct thorough utilization reviews to determine the necessity and...

  • Utilization Management Nurse Consultant

    2 weeks ago

    Charleston, West Virginia, United States CVS Health Full time

    Job SummaryCVS Health is seeking a highly skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical review team, you will play a critical role in ensuring that our members receive the highest quality care while also promoting cost-effective and efficient healthcare delivery.Key ResponsibilitiesReview and evaluate...

  • Dental Hygienist

    4 weeks ago

    Charleston, West Virginia, United States Aspen Dental Full time

    Unlock Your Potential as a Dental Hygienist at Aspen DentalAs a Dental Hygienist at Aspen Dental, you'll be part of a dynamic team dedicated to delivering exceptional patient care and promoting oral health. With a focus on patient-centered care, you'll work closely with our experienced dentists to develop personalized treatment plans and provide top-notch...

  • Dental Hygienist

    2 weeks ago

    Charleston, West Virginia, United States Aspen Dental Full time

    Unlock Your Potential as a Dental Hygienist at Aspen DentalAt Aspen Dental, we're dedicated to providing exceptional patient care and creating a supportive environment for our team members to thrive. As a Dental Hygienist, you'll play a vital role in developing patient care plans and working collaboratively with our dental team to deliver outstanding...

  • Dental Hygienist

    4 weeks ago

    Charleston, West Virginia, United States Aspen Dental Full time

    Unlock Your Potential as a Dental Hygienist at Aspen DentalAs a Dental Hygienist at Aspen Dental, you'll be part of a world-class team dedicated to delivering exceptional patient care. With our commitment to innovation and excellence, you'll have the opportunity to grow your skills and advance your career in a supportive and collaborative environment.Key...

  • Nurse Consultant

    2 weeks ago

    Charleston, West Virginia, United States CVS Health Full time

    Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical decision-making team, you will play a critical role in reviewing and evaluating clinical information and documentation to ensure that our members receive the best possible care.Key Responsibilities:Review and evaluate clinical...

  • Utilization Management Nurse Consultant

    2 weeks ago

    Charleston, West Virginia, United States CVS Health Full time

    Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical team, you will be responsible for reviewing and evaluating clinical information and documentation to ensure that our members receive the best possible care.Key Responsibilities:Review and evaluate clinical information and...

  • Utilities Foreman

    1 week ago

    Charleston, West Virginia, United States Sanders Brothers Construction Full time

    Job Title: Utilities ForemanAbout the Role:The Utilities Foreman will be responsible for managing day-to-day utility installation and repair operations, including managing personnel and projects. This role requires a strong understanding of safe digging practices, trench box usage, and installation.Key Responsibilities:Manage the day-to-day water, sewer, and...

  • Dental Office Receptionist

    2 weeks ago

    Charleston, West Virginia, United States Howard and Howard Dental Full time

    Job SummaryWe are seeking a highly skilled and organized Dental Receptionist to join our team at Howard and Howard Dental. The ideal candidate will possess excellent communication and customer service skills, with the ability to multitask and work in a fast-paced environment.Key ResponsibilitiesAnswering phones and responding to patient inquiriesScheduling...

  • Dental Assistant

    4 weeks ago

    Charleston, West Virginia, United States Harleston Dental Llc Full time

    Job OpportunityWe are seeking a highly skilled and motivated Dental Assistant to join our dynamic team at Harleston Dental LLC. As a key member of our clinical team, you will play a vital role in providing exceptional patient care and supporting our doctors in delivering top-notch dental services.ResponsibilitiesProvide exceptional patient care, ensuring a...

  • Dental Care Specialist

    1 month ago

    Charleston, West Virginia, United States Creston Dental & Braces - a Benevis company Full time

    Be a Part of Our TeamWe are seeking a skilled Licensed Dentist to provide exceptional dental care to children and adults in our community.About the RoleProvide dental services to patients, utilizing DentaPro software and digital x-ray units.Work with a patient base primarily aged 3-21, with up to 30% adult population.Enjoy a guaranteed base pay with uncapped...

  • Utility Worker

    2 weeks ago

    Charleston, West Virginia, United States Taher Full time

    Job SummaryWe are seeking a highly motivated and detail-oriented Utility Worker to join our team at Taher, Inc. As a Utility Worker, you will play a critical role in maintaining a clean and safe work environment, ensuring the highest standards of food safety and quality.Key ResponsibilitiesWash, sanitize, and put away dishes, pots, pans, and utensils in a...

  • Dental Care Specialist

    1 week ago

    Charleston, West Virginia, United States Creston Dental & Braces - a Benevis company Full time

    We are seeking a skilled Associate Dentist to join our team at Benevis. As a key member of our dental care team, you will provide high-quality dental services to patients of all ages, with a focus on children and families.Key Responsibilities:Provide dental services to patients with the support of our experienced teamCollaborate with colleagues to ensure...

  • Dental Hygiene Professor

    4 weeks ago

    Charleston, West Virginia, United States The College of Southern Nevada Full time

    About the PositionThe College of Southern Nevada is seeking a highly qualified Dental Hygiene Instructor to join our team. As a key member of our faculty, you will be responsible for teaching and mentoring students in our Dental Hygiene program.Key ResponsibilitiesProvide didactic instruction in the Baccalaureate and/or Baccalaureate Completion...

  • Dental Hygiene Instructor

    2 months ago

    Charleston, West Virginia, United States The College of Southern Nevada Full time

    About the PositionThe College of Southern Nevada is seeking a highly qualified Dental Hygiene Instructor to join our team. As a key member of our faculty, you will be responsible for teaching and mentoring students in our Dental Hygiene program.ResponsibilitiesProvide didactic instruction in the Baccalaureate and/or Baccalaureate Completion Program.Provide...

  • Dental Hygiene Instructor

    1 month ago

    Charleston, West Virginia, United States The College of Southern Nevada Full time

    About the PositionThe College of Southern Nevada is seeking a highly qualified Dental Hygiene Instructor to join our team. As a key member of our faculty, you will be responsible for teaching and mentoring students in our Dental Hygiene program.ResponsibilitiesProvide didactic instruction in the Baccalaureate and/or Baccalaureate Completion Program.Provide...

  • Dental Hygiene Instructor

    2 weeks ago

    Charleston, West Virginia, United States The College of Southern Nevada Full time

    About the PositionThe College of Southern Nevada is seeking a highly qualified Dental Hygiene Instructor to join our team. As a key member of our faculty, you will be responsible for teaching and mentoring students in our Dental Hygiene program.ResponsibilitiesProvide didactic instruction in the Baccalaureate and/or Baccalaureate Completion Program.Provide...

  • Dental Front Office Assistant

    1 month ago

    Charleston, West Virginia, United States Cabin Creek Health Systems, Inc. Full time

    Job SummaryCabin Creek Health Systems, Inc. is seeking a highly skilled and organized Dental Front Office Assistant to join our team at our Charleston West Virginia – Westside Health Center. As a key member of our dental team, you will be responsible for providing exceptional patient support services and ensuring the smooth operation of our front...

Dental Utilization Manager

2 months ago

Charleston, West Virginia, United States LIBERTY Dental Plan Full time

Transforming Oral Health Care with Excellence

We are seeking a highly skilled CONTRACT STAFF DENTIST to join our team at LIBERTY Dental Plan

Requirements:

  • Must have an active, unrestricted license/certification as DDS or DMD with 5+ years of experience as a practicing dentist.

Key Responsibilities:

  • Conduct clinical review of claims and pre-authorizations for all lines of business and/or markets as needed to ensure timely oral health decision-making and adjudication of dental claims and prospective requests for dental services.
  • Participate in clinical trainings, calibrations, and Interrater reliability testing while meeting all required quality and calibration benchmarks.
  • Participate in Quality Management and Improvement activities, DCM and SIU activities, and recommend actions to resolve identified provider trends and treatment patterns.
  • Conduct Peer-to-Peer calls to discuss utilization trends, quality 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 quality issues and trends in prospective and retrospective claims submissions.
  • Examine dental charts for focused 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 make appropriate dental interpretations and decisions.
  • Develop and maintain subject matter expertise in LIBERTY dental benefit plans and applicable State Medicaid Programs.
  • Participate in Quality Improvement and Provider Credentialing Committees and provide input on appropriate resolution of member and/or provider grievances.
  • Collect and evaluate data from Grievance, Peer Review, Public Policy, and the Credentialing Sub-Committee on a quarterly basis.
  • Participate in enrollee Tele-dentistry visits to provide clinical assessment, evaluations, and recommendations based on dental need.
  • May consult periodically with Dental Board-eligible and/or certified specialist or academic specialist within the community to make informed decisions for individual enrollees.

Education/Experience:

  • Minimum DDS/DMD Degree.
  • Active, unrestricted license or certification to practice dental or related health profession in West Virginia in good standing.
  • Minimum 5 years of clinical dentistry experience.

Specific Skills and Knowledge:

  • Demonstrated performance in managing oral health care cost and utilization management.
  • In-depth knowledge of commercial and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape, and quality improvement initiatives.
  • Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.
  • Ability to examine and read dental radiographs and chart records.
  • Ability to be successfully credentialed and re-credentialed by LIBERTY Dental Plan.
  • Must comply 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 acquire working knowledge of new system applications.
  • Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted professional protocols or guidelines.
  • Ability to work in a team providing leadership and implementing the consensus or organizational required activities.
  • Complete all necessary CE credits associated with maintaining your dental licensure.
  • Additional state licensures may be needed to meet regulatory needs of the company.

Work Environment:

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.