Description
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: Lead and coordinate dental activities and provide communication between the Contractor, ADHS and AHCCCS. Oversee the verification of services provided are medically necessary, within contract and legal guidelines, and paid appropriately according to contract and benefit limitations. Oversee the application of appropriate clinical knowledge in authorization decisions and as well as adherence to regulatory and client requirements as they pertains to benefit payments.
- Design, implement, and evaluate processes to promote and monitor optimal use of dental services by eligible populations, reduce no-show appointment rates for dental services and provide targeted outreach to those members who did not show for appointments.
- Participate in tracking and trending of quality of care issues as related to dental services.
- Review dental services and provider consultations issuing denials for requests as appropriate.
- Oversee and conduct utilization review.
- Design and implement program(s) to improve oral health utilization.
- Collaborate to increase the EPSDT dental participation rates utilizing methodologies developed by CMS.
- Educate provider agencies and case managers how to access dental benefits available to eligible populations.
Education/Experience:
- Doctor of Dental Surgery (DDS) or Doctor or Dental Medicine (DMD) degree from a university-based dental education program accredited by the American Dental Association Commission on Dental Accreditation. 1
- 10+ years of clinical dental practice experience, including 3+ years of experience in insurance or benefits administration setting.
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
