Utilization Management Reviewer
5 days ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose:
- Authorize and review utilization of dental services provided in provider offices, community health centers, hospitals, and out-of-network settings based on medical necessity, eligibility, and in accordance to contract language.
- Identify placement settings that offer the lowest level of restriction and greatest level of autonomy for the members based upon medical necessity.
- Monitor quality of care and collect and analyze utilization data.
- Serve as a resource between the health plan, provider relations, and dental providers.
- Review treatment plans and initial evaluations.
- Comply with performance measures in regards to denials and concurrent review timeliness.
- Develop and maintain collaborative relationships with providers and educate on levels of care.
- Performs other duties as assigned.
- Complies with all policies and standards.
We are seeking a Licensed Dental Hygienist to join our team The ideal candidate will bring expertise in:
- Unrestricted Licensed Dental Hygienist in the State of Georgia.
- 3+ years of Utilization Management or Clinical Experience in a Dental Office Setting.
- Strong Computer Skills.
- Deep Clinical Knowledge and Understanding of Dental Coding.
- Excellent Customer Service and Communication Skills.
Education/Experience:
- Graduate of accredited school of Dental Hygiene.
- 3+ years of utilization management or clinical experience in a dental office setting.
- Previous experience documenting in Case Management or Utilization Management systems preferred.
Licenses/Certifications:
- Possess an active, professional and unrestricted license as a Licensed Dental Hygienist to practice as a health professional in a state or territory of the United States.
- The license has a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review.
Pay Range: $26.50 - $47.59 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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Atlanta, GA, United States Compunnel Full timeThe Registered Nurse (RN) Utilization Review is responsible for evaluating the medical necessity and appropriateness of outpatient services to ensure quality and cost-effective patient care. This position involves applying evidence-based clinical guidelines and organizational criteria to review cases, support care management decisions, and collaborate with...
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