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Dental Affordability Manager - Telecommuter
| Hours | Full-time, Part-time |
|---|---|
| Location | Maryland Heights, MO Maryland Heights, Missouri |
About this job
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)
The Dental Affordability Manager - Telecommuter position will be responsible for managing affordability initiatives and projects related to Dental Utilization Management, including Dental organization Medical Necessity Utilization Review and Prior Authorization, claims adjudication including utilization edits, client remediation, related compliance/vendor oversight activities and coordination of internal and external teams in the US and overseas.
Primary Responsibilities:
- Manage Dental Organization Medical Necessity Utilization Review (UR) process, including establishing protocols and systems for case selection, claims process flow, non-professional and professional review and referral to external UR vendors
- Manage and/oversee external Utilization Review vendors
- Manage dental affordability initiatives and projects
- Manage compliance issues related to Utilization Review including audits, Policies and Procedures, and interface with legal and other functions
- Generate reports and PowerPoint presentations summarizing affordability and UR initiatives, projects and results
- Role will be 50% leading projects and 50% program development, administrative, etc
- Coordinate with Networks, Legal and other functions
Requirements
Required Qualifications:
- BS/BA in business or related field
- 5+ years of solid, robust analytics expertise including mastery of SQL, Excel, PowerPoint
- 5+ years health care experience
- 2+ years' project leadership
- Demonstrated implementation of affordability initiatives
- Ability to work in highly independent in matrix organization
- Claims processing and provider reimbursement experience
Preferred Qualifications:
- Vendor oversight relationship management
- Dental experience
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Diversity creates a healthier atmosphere: 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: Utilization Review, Prior Authorization, claims adjudication, claims processing, provider reimbursement, dental experience, SQL, telecommuter
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