Utilization Management Reviewer - Dental

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act