Surveillance Utilization Dental Consultant (Roseville, CA)

Summary

Gainwell Technologies Surveillance Utilization Dental Consultant is responsible for supporting activities to detect and report potential fraud, abuse and quality of care issues within the Medi-Cal Dental Program as a part of Compliance Management. This role serves to help maintain the integrity of the Program. You will play a vital role in identifying areas for improvement and assisting in implementing strategies to enhance Program performance.

Your role in our mission

• Review and analyze the delivery, billing, and utilization of services on a case-by-case basis, to detect unusual practices, billing anomalies and potential abuse by Medi-Cal providers and/or members
• Configure, run queries and conduct analyses of claims data, patient dental records and results of clinical screening examinations to detect aberrant provider behavior
• Collect, track, follow up and analyze referrals of potential fraud, abuse and substandard quality of care
• Create, edit and present results of surveillance and utilization review findings via written report and verbal presentations
• Make recommendations to guard against fraudulent or abusive use of services by either providers or members

What we're looking for

• A minimum of ten (10) years of experience as a dentist. Must hold an active CA dental license, in good-standing and free of any suspensions or sanctions from Federal, State or local jurisdictions.

• Proficiency in creating, querying, and analyzing reports
• Strong writing skills with the ability to convey complex utilization data in a clear and actionable manner
• Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Position is hybrid (2 days in person in our Roseville, CA office and 3 days working from home). Will need to be a California resident.

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Computer for work is company-provided.
• Monday through Friday work schedule.
• Our hybrid schedule is working from home on three days per week and in the Roseville, California office on other days.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
    • Go to Google.
    • Search for Internet Speed Test.  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

This position is intended for pipelining. We will accept applications on an ongoing basis until all positions are filled.

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