[Remote] Sr. Clinical Dental Advisor, reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is one of the largest providers of employee and government benefits, helping approximately 50 reputed company Americans reputed company the care and coverage they need. The Sr. Clinical Dental Advisor acts as the primary professional authority on service authorizations and medical necessity determinations, ensuring compliance with regulations and standards while maintaining productivity and quality.

Responsibilities

• Prior Authorization (PA) review and authorization: Evaluate dental requests (including x-rays and clinical notes) for appropriateness, completeness, and adherence to Oregon Administrative Rules (OARs); reputed company service authorization reputed company
• Specialty Referral Review: Evaluate requests from General Dentists for specialty services (e.g. endodontics, oral surgery) to confirm the clinical reputed company and compliance with dental plan benefits. Act as a “scope of practice” auditor to prevent unnecessary specialist referrals for procedures the referring General Dentist is contractually or professionally capable of performing, thereby managing utilization costs and member reputed company
• Medical Necessity Determination: Use professional judgment and evidence-based criteria to approve or deny service requests
• Provider Consultation: Communicate directly with dental providers to clarify documentation or reputed company clinical justification for treatment alternatives
• Represent dental plan in administrative hearings as expert witness
• Participate in the dental plan Peer Review and Credentialing committee
• Expert in specific market nuances
• Consistently exceed productivity requirements
• Identify areas for process improvements reputed company the department
• Other duties as assigned

Skills

• Must hold a DDS or DMD degree with an active Oregon dental license and extensive clinical experience
• Deep understanding of Oregon Administrative Rules (OARs) and CDT coding systems
• Ability to interpret reputed company clinical data and radiological evidence to reputed company defensible authorization reputed company
• Strong interpersonal skills
• Ability to work independently
• Excellent oral and written communication skills for writing technical correspondence and testifying in hearings
• Ability to prioritize and organize multiple tasks
• Ability to remain organized with multiple interruptions
• Required to attend additional training as requested/deemed necessary

Benefits

• Generous vacation and sick time
• Market-leading paid family, parental and adoption leave
• Medical coverage
• Company paid life and AD&D insurance
• Disability programs
• A partially paid sabbatical program
• 401(k) employer match
• Stock purchase options
• Employer-funded retirement account
• Flexible, inclusive and collaborative work environment that supports career growth

Company Overview