The Staff Dentist performs timely and clinically sound reviews of dental claims, prior authorizations, and treatment requests to ensure evidence-based care. They also collaborate with providers and internal teams to support quality improvement, regulatory compliance, and consistent coverage determinations.
The Staff Dentist will conduct utilization management and clinical reviews of dental claims, prior authorizations, and treatment plans to ensure evidence-based care. They will also collaborate with providers and internal teams to maintain clinical consistency and regulatory compliance across various lines of business.
The Senior Staff Dentist provides clinical leadership for utilization management and review programs to ensure appropriate dental care adjudication. They also engage in quality improvement initiatives, provider counseling, and clinical mentorship to support organizational compliance and performance goals.
The Staff Dentist will review dental claims and prior authorization requests to ensure clinical necessity and adherence to benefit policies. They will also participate in peer-to-peer consultations and collaborate with internal teams to maintain clinical quality and consistency.
The IT Applications Engineer is responsible for maintaining, supporting, and enhancing business applications across production and non-production environments. This role involves collaborating with vendors and internal teams to troubleshoot issues, manage deployments, and ensure overall application stability.
The IT Operational Analyst serves as a liaison between business units and IT teams to translate business needs into technical requirements. They are responsible for analyzing system performance, identifying process improvements, and supporting the implementation of technology solutions.
The Quality Program Administrator manages Medicaid and Medicare quality programs by ensuring regulatory compliance and operational excellence. They facilitate cross-functional projects, analyze performance data, and prepare reports to drive continuous quality improvement.
The Manager of Grievance & Appeals oversees the grievance system, ensuring all member and provider disputes are resolved in compliance with state and federal regulations. This role also drives quality improvement initiatives, manages audit preparedness, and collaborates across departments to implement process improvements.
Lead and mentor a team of systems engineers while driving operational excellence and infrastructure reliability. Oversee requirements management, system architecture, and verification processes to ensure compliance and performance.
The State Fair Hearing Analyst manages Medicaid Fair Hearing cases by preparing detailed legal documentation, evidence, and case analyses. They represent the organization during hearings and collaborate with internal teams and state regulators to ensure compliance.
The System Configuration Analyst will coordinate and execute claims and utilization management system configurations while ensuring alignment with benefit designs and regulatory standards. This role involves collaborating with cross-functional teams to test system logic, audit rules, and support new business implementations.
Review dental claims and prior authorization requests to ensure medical necessity and adherence to coverage guidelines. Collaborate with clinical leaders and providers to maintain consistency in clinical determinations and support quality initiatives.
