The Staff Dentist performs utilization management by reviewing dental claims, prior authorizations, and appeals to ensure clinical consistency and regulatory compliance. They also collaborate with providers and clinical teams to support evidence-based care and quality improvement initiatives.
The Senior Staff Dentist provides clinical leadership for utilization management and review programs to ensure appropriate dental care adjudication. They also participate in quality improvement initiatives, provider engagement, and peer review activities to maintain regulatory compliance and high standards of care.
The Staff Dentist reviews dental claims and prior authorization requests to ensure clinical necessity and adherence to benefit policies. They also engage in peer-to-peer consultations and collaborate with internal teams to maintain quality and regulatory standards.
The System Configuration Analyst will coordinate and execute claims and utilization management system projects while ensuring accurate benefit implementation. They will also collaborate with cross-functional teams to audit system rules, analyze complex scenarios, and maintain departmental policies.
Review dental claims and prior authorizations 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.
