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Remediation / Surveillance Utilization Dental Consultant (Roseville, CA)

Date:  Sep 7, 2023

Roseville, CA, US, 95747-6645

Req ID:  18821

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.



Gainwell Technologies Remediation / Surveillance Utilization Dental Consultant is responsible for supporting activities to support and monitor providers on prior authorization or special claims review (PA/SCR) remediation to detect and reduce 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.
  • Communicate with and support dental providers placed on remediation activities.
  • Monitor providers on PA/SCR remediation, including processing of treatment authorization requests (TAR) and claims processing for providers on remediation.
  • Work closely with the CA Department of Health Care Services to identify and review provider training and recommendations for provider graduation from compliance review/remediation.
  • Create, edit, and present results of remediation activities of surveillance and utilization review findings via written reports and verbal presentations.

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 communication skills both in writing and verbal methods
  • Demonstrated expertise and knowledge of Medi-Cal Dental criteria and program requirements. Experience in fraud and abuse detection preferred.
  • Position is hybrid or on-site (Roseville, CA), to be determined.

What you should expect in this role

  • Full-time work schedule (40 hours per week)
  • If this position is ever hybrid (working from home some days) a minimum internet connection speed of 24MBS download and 8 MBS upload is required
  • Benefits start on first day of employment.
    • Health, Dental, Eye are optional (specific rates only discussed in new hire orientation)
    • Flexible PTO policy
    • Continuous training to promote career progression.






The pay range for this position is $116,100 – $165,900 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.

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