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) In collaboration with, and supervision by the Clinical Appeals RDH. The Registered Dental Hygienist (RDH) is responsible for ongoing clinical review and recommendation of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include: Primary Responsibilities: Work as part of an integrated team of dental director dentists, other functional areas, and other members of the appeals staff Perform individual case review for appeals and grievances for various healthplan and insurance products, which may include Indemnity, PPO, ASO, and HMO, The appeals are in response to adverse determinations for dental services related to benefit design and coverage, dental necessity, and the application of clinical criteria of dental policies Communicate with UnitedHealthcare Clinical Appeals RDH Manager and dental directors regarding appeals recommendation rationales and benefit interpretations Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results Participating in organizational committees, projects, and task forces, as appropriate
Required Qualifications:Registered Dental Hygienist (RDH) with an active, unrestricted license 5 + years clinical practice experience Experience with dental claims coding and review Excellent project management skills. Familiarity with current dental issues and practices Strong team player Excellent communication skillsPreferred Qualifications:Intermediate level experience in dental managed care 2+ years dental Quality Management experience desirable Intermediate presentation skills for both clinical and non clinical audiences. Creative problem solving skills. Basic computer skills, typing, word processing, presentation, and spreadsheet applications skills Internet researching skillsCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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: RHD, Clinical Appeals, Claims, Dental Claims, Dental Claims review, Dental Quality, Audit, MS Word
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.