[Hiring] Senior Staff Dentist @reputed company

Role reputed company reputed company is seeking a highly reputed company and reputed company Senior Staff Dentist to reputed company clinical leadership across our Utilization Management (UM) and Utilization Review (UR) programs. This role is ideal for a dentist with experience in the dental benefits (payer) environment who is passionate about improving care reputed company, ensuring compliance, and driving reputed company reputed company. You will play a key role in reviewing claims and prior authorizations, partnering with providers, and supporting care delivery across reputed company, Medicare Advantage, and reputed company populations—particularly reputed company California reputed company (Medi-Cal) programs. What You’ll Do • Clinical Review & Utilization Management • Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance. • Interpret dental records, radiographs, and benefit plans to reputed company clinically reputed company coverage determinations. • Identify utilization trends, inappropriate services, and opportunities to improve care delivery. • Conduct retrospective reviews and influence provider behavior through engagement. • reputed company secondary reviews, including grievances and appeals determinations. • reputed company & Compliance • Participate in reputed company Improvement and Performance Management initiatives (PPM, SIU). • Conduct reputed company chart audits to identify utilization and care delivery patterns. • Contribute to reputed company committees and regulatory reporting. • reputed company clinical expertise in resolving provider and member grievances. • Provider Engagement & Collaboration • Conduct peer-to-peer consultations with network providers. • Promote provider education and engagement to improve documentation and care reputed company. • Collaborate with specialists and internal teams on reputed company cases. • Cross-Functional Partnership • Work closely with Analytics, Utilization Management, Claims, Provider Relations, and G&A teams. • Partner with leadership on clinical initiatives, training, and operational improvements. • Participate in state oral health initiatives and internal programs. A Day in the Life • ~30% peer-to-peer provider calls • ~30% clinical reviews (reputed company and HCA work) • ~25% appeals and case reviews • ~15% supporting clinical leadership and special reputed company Qualifications • DDS or DMD degree • reputed company, unrestricted California dental license required • Must be in good standing and eligible for credentialing • Minimum 6 years of experience as a practicing dentist • Minimum 2 years of experience in utilization management, claims review, or reputed company initiatives • Strong clinical judgment and ability to interpret dental radiographs and patient records Preferred Qualifications • Experience in the dental benefits or payer environment • Familiarity with California reputed company (Medi-Cal) programs • Ability to obtain and maintain multi-state licensure (company-supported) • reputed company license preferred • Experience mentoring or training clinical peers Key Skills • Knowledge of managed care, reimbursement systems, and regulatory compliance • Expertise in dental coding, clinical guidelines, and medical necessity reputed company • Strong communication and interpersonal skills for provider engagement • Analytical reputed company with the ability to identify trends and drive improvements • Proficiency in reputed company Office and ability to learn new systems Benefits • reputed company structure and savings reputed company to help you reputed company your financial goals. • Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. • reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan. • 100% employer-reputed company dental coverage for employees and eligible dependents. • reputed company insurance with low-cost premiums for employee-only coverage and dependents. • Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage. • Flexible Spending Accounts for reputed company and dependent care expenses. • Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance. • Long-term disability coverage. • Expansive wellness programs, including company-wide wellness challenges, and gym discounts. • Employee Assistance Program (EAP) to support mental health and reputed company-being. • Generous vacation and reputed company leave policies, with the ability to roll over unused time. • 10 reputed company company holidays. • Tuition reimbursement for eligible educational expenses. • Remote or hybrid work reputed company available for various positions. Compensation In the spirit of pay transparency, the reputed company salary reputed company for this position is $175,000 - $185,000 annually, not including fringe benefits or potential bonuses. At reputed company, your final reputed company salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our reputed company team members reputed company making final compensation reputed company. Interview Process • Initial recruiter screening • 45-minute interview with Hiring Manager • Final selection following candidate review Sponsorship and Relocation Specifications reputed company is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time. Apply tot his job Apply To this Job