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Dentist Reviewer, Appeals and Grievances - Telecommute EST or CST only

Company: UnitedHealth Group
Location: Minnetonka
Posted on: January 7, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)Position will support Dental Appeals and Grievances by performing clinical review of member records, performing medical necessity review, providing clinical support to resolve dental appeals and grievances following established Company policies and review criteria.If you are located in EST or CST, you will have the flexibility to telecommute* as you take on some tough challenges.Primary Responsibilities:

  • Perform individual case review for appeals and grievances. The Appeals are in response to adverse determinations for dental services related to benefit design and coverage, medical necessity and the application of clinical criteria and dental policies, the Clinical Grievances are related to the quality of care provided by contracted dentists
  • Communicate with other dental reviewer or director regarding appeals and grievances for recommendation rationales and benefit interpretations
  • Help develop policies and procedures related to Appeals and Grievances by providing clinical and strategic input
  • Resolve Clinical Appeals and Grievances disputes with dental providers
  • Generate management reports on key activities; provide clinical support to the team in producing presentations and reports
  • Assist with special Appeals and Grievances projects as directed
  • Interact with internal stakeholders regarding Appeals and grievances matters
  • Participate in peer-to-peer call with dental providers where requiredYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
    • Dental degree from an Accredited Dental School
    • Active dental license in the State of Residence
    • 5+ years of experience in a dental practice
    • 3+ years dental benefit plan experience with specific exposure to claim review and utilization management or comparable experience
    • Ability to pass a credentialing review for practice experience
    • Comprehensive knowledge of Utilization Review
    • Experience with Fraud, Waste and Abuse investigations
    • Proficient with Microsoft Word, PowerPoint, Excel
    • Excellent business analytical and writing skills
    • Located within Eastern or Central time zone -Preferred Qualifications:
      • Completion of post graduate dental residency
      • History of strong presentation skill
      • Microsoft AccessTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Ac tion employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. -UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords:: Dental, DDS, Dental Practice, License, Managed Care, Appeals, Grievances, Claim Review, Utilization Review, Fraud, Waste, Abuse, Telecommute, UHC, UnitedHealthcare Telecommute, Telecommuter, Telecommuting, Work at Home, Work from Home, Remote, Baltimore, MD, Providence, RI, Dallas, TX, Richmond, VA, Chicago, IL, Atlanta, GA

Keywords: UnitedHealth Group, Minnetonka , Dentist Reviewer, Appeals and Grievances - Telecommute EST or CST only, Healthcare , Minnetonka, Minnesota

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