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 UM Dental Reviewer - Telecommute in Texas Preferred - SAN ANTONIO, Texas, United States

Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Health - Dentistry (not MD)
Travel: Minimal 
Accept candidates: from anywhere 
Languages: English - Fluent
Spanish - Fluent
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 875529 / Latpro-3745209 
Date posted: Jun-26-2020
State, Zip: Texas, 78201


For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work. (sm)

Position will support Dental Utilization Management and Utilization Review by performing clinical review of member records, performing medical necessity review, providing clinical support to Fraud, Waste and Abuse, and remediating provider behavior.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Review/audit member records to validate claims submission accuracy and identify potential quality of care issues
  • Review/audit medical necessity review determinations made by dental consultants to determine if UHC review criteria were followed
  • Lead the remediation of providers as the result of Fraud/Abuse and other investigations including provider outreach, counseling and correspondence; coordinate with the Peer Review Committee, Legal and other internal departments; and interface with external entities including regulators and law enforcement
  • Develop policies and procedures related to Utilization Review and Fraud/Abuse
  • Provide clinical expertise in support of Fraud, Waste and Abuse, Payment Integrity, Affordability and related projects
  • Resolve clinical cases and disputes with dental providers
  • Generate management reports on key activities; provide clinical support to the team in producing presentations and reports
  • Assist with special UM projects as directed
  • Interact with internal stakeholders regarding UM matters
  • Participate in peer-to-peer call with dental providers where required

You’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 Texas
  • 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
  • Strong PC skills including Microsoft Word, PowerPoint, Excel

Preferred Qualifications:

  • Completion of post graduate dental residency
  • Bilingual Spanish
  • History of strong presentation skill
  • Resides in Texas
  • Microsoft Access
  • Excellent business analytical and writing skills

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 Action 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, Bilingual, Spanish, Claims, Dental Reviewer, Dentist, Claim Review, Utilization Review, Utilization Management, Fraud, Waste And Abuse, San Antonio, Dallas, Houston, Lubbock, TX, Texas, Telecommute, Telecommuter, Telecommuting, Remote, Work From Home, Work At Home, UHC, UnitedHealthcare, UnitedHealth Group, UHG


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