Performance Management Dental Consultant Manager - Roseville, CA (Hybrid)

Date: Sep 13, 2023

Location:

Roseville, CA, US, 95747-6645

Req ID: 19407

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

Gainwell Technologies Performance Management Dental Consultant Manager is responsible for supporting and overseeing Compliance Management activities including surveillance utilization and review, in addition to supporting audits and litigation, to assist in maintaining the integrity of the Medi-Cal Dental 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

Provide support, oversight, reporting and serve as an escalation point for Compliance Management (surveillance utilization and review) and audits and litigation activities, following Program policies and standards
Monitor, analyze and report 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
Report directly to the Dental Director to provide objective compliance reviews and data-driven recommendations to guard against fraudulent or abuse use of services and ideas for improvement
Develop, implement, provide and track training, development and guidance to team members and Medi-Cal providers to align provider services and billing patterns with recognized standards
Collaborate with internal and external stakeholders, including but limited to the Department of Health Care Services Audits and Investigation Division, Medi-Cal Dental Services Division (MDSD), Care Management, and Operations Management staff

What we're looking for

A minimum of ten (10) years of experience as a dentist. Must be a CA resident and hold an active CA dental license in good-standing and free of any suspensions or sanctions.

A minimum of five (5) years of experience as a team leader or supervisor.
A minimum of five (5) years proven experience in performance management, compliance management, fraud/waste/abuse, and/or surveillance utilization and review
Demonstrated expertise and knowledge of Medi-Cal Dental Program criteria.

What you should expect in this role

Full-time (40 hour) per week position
Hybrid work environment 1-2 days a week in the office, and as needed for face-to-face and client meetings, with the remainder of time remote work. The office is located in the Roseville/Sacramento area.
In order to effectively work from home on days not in the office with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
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The pay range for this position is $190,100.00 - $271,500.00 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.