Centene Corporation Dental Clinical Director Atlanta, Georgia Apply Now
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: The Dental Clinical Director provides professional judgment to adjudicate prior authorization, claims, and appeals submissions to help Envolve Dental appropriately manage state Medicaid, Marketplace, and federal Medicare utilization and expense control. Appropriate and clear adjudication decisions also contribute to member and provider satisfaction. The Dental Clinical Director also helps create, implement, and carry out dental clinical policy that is consistent with American Dental Association evidence-based guidelines and with the various dental specialty association guidelines. This is a highly visible and key role in maintaining Envolve Dental's position and reputation in the dental insurance marketplace.
Responsibilities:
- Review and decision prior authorization and claim submissions
- Review and decision member and provider appeals
- Participate on committees as requested
- Develop and evaluate clinical policies
- Provide guidance and subject matter expertise to health plans
- Provide clinical specialty guidance to dental leadership
- Perform other duties as assigned
- Comply with all policies and standards
Education/Experience: DDS/DMD degree required. 5 years of experience in dental claims and knowledge of dental or orthodontic care that comes with being a General Dentist or Specialty Dentist.
License/Certification: DDS or DDM degree and valid dental license.
Pay Range: $162,200.00 - $308,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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