Adjudication Dental Consultant Manager- Roseville, CA

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies Adjudication Dental Consultant Manager applies clinical expertise, knowledge of Medi-Cal Dental policies, and people leadership to oversee and supervise a team of dental consultants who review, approve, and/or deny dental claims and treatment authorization requests in accordance with CA Department of Health Care Services (DHCS) Medi-Cal Dental policies.

Your Role in Our Mission

• Supervise adjudication staff, including but not limited to, assigning and monitoring daily work and outputs, monitoring attendance and out-of-office requests, resolve team issues, to meet Medi-Cal Dental contract requirements. 
• Provide coaching to staff members when quality, or other, metrics fall below the established baselines.
• Assist in the development, delivery and updating of training materials, manuals and standard operating procedures (SOPs) for staff members to adjudicate Treatment Authorization Requests (TARs), Notices of Authorization (NOAs), Claim Inquiry Forms (CIFs) and claims utilizing standards and procedures set forth by the CA Department of Health Care Services (DHCS) to ensure adherence to Medi-Cal Dental policies and procedures.
• Attend meetings and provide recommendations to improve operational efficiencies and accuracy.
• Assist other departments, when requested: a) Document Processing Center, b) Provider and Member Services, c) Grievances/Appeals, d) HR/Onboarding/Interviews, e) Quality Management, f) Peer review, and g) Providing data to other internal departments

What We’re Looking For

• A minimum of ten (10) years of prior hands-on, clinical experience as dentist delivering dental services. The candidate must meet all requirements and training set forth by the Board of Dental Examiners in California.
• Possession of an active (non-expired) license to practice dentistry in CA, which is in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions.
• A minimum of three (3) years of experience as a team leader or supervisor

• Expertise and knowledge of Medi-Cal Dental criteria and program requirements.
• Prior adjudication and claims processing for Medi-Cal Dental in California is a plus, but not a requirement.
• Position is Hybrid (Roseville, CA) – must be a California resident  

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The pay range for this position is $148,300.00 - $180,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.