Remediation/Surveillance Utilization Dental Consultant - Roseville, CA

Date: Dec 20, 2024

Location:

Roseville, CA, US, 95747-6645

Req ID: 28134

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' 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 request (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 report and verbal presentations

What we're looking for

A minimum of ten (10) years of experience as a dentist. Must also 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
Hybrid position (2 days in Roseville, CA office and 3 days remotely from home)

What you should expect in this role

This is a full-time permanent regular salaried (W-2) employee position.
- Monday through Friday work schedule (40 hours per week).
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 company provided.
For all hybrid 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.

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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.