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The primary role for the Texas Dental Fair Hearing Dental Consultant is to provide oversight of all state Fair Hearing activities. The position requires that the Texas Dental Fair Hearing Dental Consultant perform a clinical review of the case, provide an explanation and justification for the determination, have knowledge of members appeal determination, and present clinical justification for this decision at the Fair Hearing. Most of Dental Fair Hearing meetings take place telephonically, however the state may require an in-person hearing for special circumstances.

This role will also be the primary clinical reviewer for vendor authorization and claim adjudications, and appeal and complaint decisions, reporting outcomes to the Dental Director. The TX Dental Clinical Consultant also provides clinical guidance and education to provider-support teams and delegated clinical review vendors around adherence to the established clinical criteria, and also serves as Clinical SME to the TX Dental Plan and necessary committees.

If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provide clinical review and justification prior to Dental Texas Fair Hearing Meetings
• Attend (in-person or telephonically) Dental Texas Fair Hearing Meetings
• Assist in coordinating any determination decisions made at the Dental Texas Fair Hearing Meetings
• Support the Dental Director in review of Utilization Management
• Clinical review of Appeals, Complaints, and Authorization Requests
• Support the Dental Director and QI Director in Clinical and Quality programs and initiatives
• Serve as clinical advisor to Quality Improvement Committee, Dental Medicaid Utilization Management Committee, Dental Advisory Committee
• Provide support in tracking and trending provider activity
• Provide support to the Dental Director for any state meetings or meetings with external advocacy groups or clients
• Review any materials that contain clinical information for appropriateness and accuracy

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Dental degree from an accredited Dental School
• Current unrestricted Texas Dental Licensure
• Current resident of TX
• 5+ years of clinical dentistry practice
• Proven intermediate level writing skills and presentation skills
• Proven knowledge about current dental concepts and practices
• Proven basic computer skills – Microsoft Office (Word, Excel, Outlook, Teams, PowerPoint), typing, word processing, presentation, and spreadsheet application skills, including internet researched skills

Preferred Qualifications:

• Experience with insurance and managed care
• Experience with quality of care reviews and standards
• Experience with claims coding and review
• Working knowledge of Medicaid or Medicare regulations/populations
• Intermediate Microsoft Office skills (Excel, PowerPoint)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.