Dental Physician Reviewer

3 weeks ago

Hattiesburg, Mississippi, United States Acentra Health Full time
About the Role

Acentra Health is seeking a highly skilled Dental Physician Reviewer to join our team. As a key member of our Utilization Management (UM) program, you will play a critical role in ensuring the delivery of high-quality healthcare services to our clients.

Key Responsibilities
  • Oversee utilization/management activities, including peer review, utilization review, fair hearings, and appeals, as well as other clinical consultations related to the applicable contract.
  • Support the Dental UM contract for Arkansas.
  • Collaborate with the Medical Director on case consultations as needed.
  • Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management Dental Hygienist Reviewers.
  • Participate in client 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 an accredited dental school.
  • Must have an 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.
Preferred 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.
  • 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.
About Acentra Health

Acentra Health is a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. We are a vital partner for health solutions in the public sector, and our mission is to empower better health outcomes through technology, services, and clinical expertise.

We are committed to providing our employees with 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.

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