Dental Hygienist Consultant

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Assess Medicaid Dental prior authorizations based on medical necessity, eligibility, state policy guidelines, and recognized dental practices.

• Analyze member Dental Histories and, on occasion, adjudicate Dental prior authorizations.

• Evaluate prior authorization submissions utilizing various computer systems.

• Request additional information or clarification from requesting providers when necessary.

• Complete adjudications for prior authorizations within the Medicaid Management Information System (MMIS).

• Engage in monthly meetings with Gainwell leadership, operational personnel, clinical colleagues, and state stakeholders.

• Offer support and guidance to providers regarding specific prior authorization submissions.

• Collaborate with the Dental team to ensure timely adjudication of Dental Prior Authorization requests.

• Review communications directed at providers and members about new or updated policies.

• Act as a clinical subject matter expert or liaison for internal Gainwell entities.

• This role does not involve direct patient interaction.

⛳️ Requirements

• A valid Dental Hygiene license in the state of WI, or a license from another state with the capability to obtain a WI license before the starting date.

• Significant experience within the Dental industry.

• Familiarity with CDC codes.

• Understanding of ForwardHealth Policy requirements associated with relevant codes.

• Knowledge of and/or experience with the Wisconsin Medicaid program or other state Medicaid programs.

• Exceptional interpersonal, oral, and written communication skills.

• Capacity to meet deadlines and prioritize tasks with minimal supervision.

• Experience collaborating with various partners or team members towards common objectives.

• Ability to communicate effectively and interpret policies and procedures.

🏝️ Benefits

• Flexible working hours.

• Work-life balance.

• Opportunities for continuous learning and career growth.

• Flexible vacation policy.

• 401(k) employer matching.

• Extensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Up to 10% travel as required.