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PT Dental Medical Director/Case Review - Meridian, United States - Idaho State Job Bank
Description
PT Dental Medical Director/Case Review#LI-Remote To be considered for this opportunity, you have:
Experience: 5 years of dental clinical practice or related experience Education: Doctorate Degree in Dental Surgery (DDS) or Doctor of Dental Medicine (DMD)
Licenses/Certifications:
Current, unrestricted dental license Ability to obtain an Idaho Dentist License within 6 months We'd also love it if you had: Managed care experience, either with a medical group or health plan Experience in dental administration In this role, we will ask you to: Interpret existing policies and develop new policies based on changes in the dental industry standards or medical evidence.
Provide guidance and direction consultation to medical directors and clinical staff in for the development of cost, utilization, and medical matters involving oral health and dental review activities, as needed.
Provide direction, support, and dental expertise to the organization in matters of case management, underwriting benefit design, new product development, claims, quality improvement, provider contracting, and other inquiries that require dental review.
Participate in and contribute to interdisciplinary case conference discussions in support of member dental care and services clinical staff development, as needed.
Participate in regulatory and oversight activities to support consistency in dental review while ensuring enforcement of member and provider contracts with state, federal, and plan dental policies and/or guidelines.
Review provider practices that need assistance to correct over-utilization of services, excessive fees, inappropriate services, or sub-optimal care. Represent the organization at professional organizations and act as a liaison with health dental services professionals and trade organizations. Performs other duties and responsibilities as assigned. Reasonable accommodations To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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