Dental Hygienist Clinical Utilization Reviewer - Remote

CNSI and Kepro are now Acentra Health! Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra seeks a Dental Hygienist Reviewer to join our growing team.

Summary Description

The Dental Clinical Specialist is responsible for the Utilization Management and Utilization Reviews to ensure the timely decision-making and adjudication of dental claims, referrals, and pre-authorizations. Prior authorization and post payment reviews leverage patient care and treatment planning experience to support the healthcare business process services team. Our client may also request evaluations of dental health policy and preventative treatment plans. The Dental Clinical Specialist will complete their work with a limited degree of supervision.

Responsibilities include, but are not limited to

• Review first-level Prior Authorization (PA) requests related to handicapping malocclusions, general dentistry requests, and treatment plan evaluations.
• Acentra Health is responsible for all levels of review:
• First-level reviews will be completed by a professional with expertise in this area.
• If a secondary review is necessary, such as denials, appeals, and fair hearings, the Dental Clinical Specialist would ensure that cases are prepared, completed within timeframes, by our peer to peer licensed dental provider.
• Ensure compliance with a turnaround time for all first-level reviews.
• Utilization Management data will be reported each month covering:
• Number of reviews
• Percent approved
• Percent denied
• Percent appealed or went to a fair hearing
• Percent upheld at appeal or fair hearing
• Percent overturned and reason
• Percent returned for additional information, trends or issues
• Develop and maintain good relationships with contracted providers.

• Consistently review and report trends, and opportunities for program improvement.
• Perform other tasks as assigned or necessary.

Requirements

• Dental Hygienist with at least three years of clinical experience.
• Experience with tools related to handicapping malocclusions, general dentistry and preventative care.
• Preferred experience working with state Medicaid programs.
• Unrestricted license in the state of Arkansas as dental hygienist

Accountabilities

• Knowledge of current dental terminology, practices, materials, and generally accepted standards, and knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures. Ability to examine and read dental radiographs and chart records.
• Follow and adhere to policies and procedures internally per OHA guidelines and OARs.
• Timely documentation which meets all best practice guidelines
• Collaboration with internal and external stakeholders.
• Communication activities which include, telephone interactions, caregiver interactions, rounds, interdisciplinary team meetings, and other related evidence-based practices.
• Ensuring quality-driven outcomes through best practice and motivational interviewing.

• Develops and maintains subject matter expertise in dental benefit plan and applicable State Medicaid Program.

Benefits

Why us?

 We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have 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.

Compensation

The pay range for this position is $68,000 - $73,000

“Based on our compensation philosophy, an applicant’s placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Thank You!

 We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at Acentra.com/careers/

EOE AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law.