Surveillance Utilization Dental Consultant

Date: Aug 31, 2023

Location:

Roseville, CA, US, 95747-6645

Req ID: 19409

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 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.

What you should expect in this role

Full-time (40 hour per week) position
Position is hybrid and/or on-site (Roseville, CA), to be determined.
In order to effectively work as hybrid or remotely 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.
To Test your internet download and upload speed:
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Search for Internet Speed Test or click here.

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The pay range for this position is $116,100.00 - $165,900.00 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.