Dental Medical Reviewer; DDS​/DMD - PRN; Remote U.S. Alaska Time Zone

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem‑solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra health is looking for a Dental Medical Reviewer (DDS/DMD) - PRN (Remote U.S. within Alaska Time Zone Hours)

Job Summary:

• The Dental Medical Reviewer Doctor of Dental Surgery (DDS) or Doctor of Medicine in Dentistry (DMD) - PRN will oversee Utilization Management (UM) activities to include peer review, utilization review, fair hearings and appeals, and other clinical consultations related to the applicable contract and will support the Dental UM contract.

Responsibilities:

• Responsible for the clinical oversight of the Dental Utilization Management program.
• Collaborate with the State Medical Director or Program Director on case consultations as needed.
• Must be available a minimum of four (4) hours per week.
• Participate in the client's quarterly and ad‑hoc contract meetings.
• Review safety, sentinel, and Quality of Care events and provide detailed feedback and recommendations as per organization and policy.
• Complete all secondary‑level Dental Utilization Management reviews.
• Develop and complete an annual review of clinical medical necessity criteria.
• Participate in appeal hearings as needed.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

The above list of responsibilities is not intended to be all-inclusive and may be expanded to include other education‑ and experience‑related duties that management may deem necessary from time to time.

PLEASE NOTE:

* This role is contingent upon being awarded a contract. Start dates and final offers are contingent upon the contract award and final contract start dates. *

* Work Hours:

Must be available for a minimum of four (4) hours per week during Alaska Time Zone business hours. *

Required Qualifications /

Experience:

• Must be available to work business hours as defined by contract within the Alaska Time Zone. AND must be available for a minimum of four (4) hours per week.
• Doctor of Dental Surgery (DDS) or Doctor of Medicine in Dentistry (DMD) degree from an accredited dental school.
• D.D.S. or D.M.D. state license in good standing (licensed in the state practicing from at a minimum).
• 5+ years of experience in Utilization Management (UM), Service Authorization (SA), or other clinical review processes for Medicaid or another large healthcare payer.

Preferred Qualifications /

Experience:

• Residency within Alaska, Pacific, OR Mountain Time Zone.
• 10+ years of clinical practice.
• 5+ years of experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs, and coaching medical staff on healthcare business and practice issues.
• 2+ years of experience as a Medical Director in a managed care company.

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Thank You! We know your…