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Dental Utilization Specialist
Ref No.: 18-01575
Location: Newark, New Jersey
Position Type:Contract
Start Date / End Date: 03/05/2018 to 09/04/2018
Position: Dental Utilization Specialist
Location: Role will be based out of Newark or Hopewell, however the position will be mobile and will require state travel
Duration: 6 Months (Potential to Perm)


Job Description:
This position is a Dental Utilization Auditor, responsible for reviewing, analyzing and monitoring the practice patterns of Dentist. This position determines whether treatment meets the appropriate standard of care and maintains cost effectiveness.-Audit patient records to evaluate practice patterns and interprets the treatment for appropriateness.
  • Consults and educates the dentists on utilization and practice patterns.
  • Suggests and helps develop corrective action plans.
  • Identify, verify, prepare and present audit findings to the UM Committee.
  • Monitor, track and report on utilization trends to support recommended alternate courses of treatment.
  • Member of the UM Committee
  • Perform other duties as assigned by management

Education/Experience:
  • Prefer a Bachelor's degree from and accredited college or university will consider work experience in a related field.
  • Requires a minimum of three (3) years- experience in a clinical setting.
  • Prefers 1 year experience the health care delivery system/industry


Additional licensing, certifications, registrations:
  • Must be licensed Dental Hygienist
  • Requires a valid Driver License

Knowledge:
  • Requires knowledge of dental products, managed and traditional
  • Prefers working knowledge of utilization review and quality management protocols.
  • Requires knowledge of CDT 2013
  • Prefers knowledge of health care contracts and benefit eligibility requirements

Skills and Abilities:
  • Requires excellent oral and written communication skills.
  • Requires the ability to work in a high volume environment with moderate supervision.
  • Requires the ability to apply an understanding of business fundamentals and administrative expense management of day to day decision making.

Travel (If Applicable):
Statewide travel required to conduct onsite audits at participating provider offices.