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Clinical Appeals Registered Dental Hygienist (RDH) Manager - Office Based In Santa Ana, Columbia, Houston

UnitedHealth Group


Location:
Houston, TX
Date:
03/24/2017
Job Code:
1736951
Apply on the Company Site
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Job Details


Clinical Appeals Registered Dental Hygienist (RDH) Manager - Office Based In Santa Ana, Columbia, Houston(Job Number:709759)
Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

 

In collaboration with the National Dental Director, the Clinical Appeals Registered Dental Hygienist (RDH) Manager is responsible for ongoing clinical review and recommendation of appeals and grievance cases for UnitedHealthcare associated companies. Performance accountabilities include:
 

Primary Responsibilities:

  • Work as part of an integrated team of dental director dentists, other functional areas, and other members of the appeals staff
  • Manages and is accountable for professional employees, i.e. RDH
  • Drives the team direction, resolves problems and provides guidance to members of own team
  • Perform individual case review for appeals and grievances for various healthplan and insurance products, which may include Indemnity, PPO, ASO, and HMO, The appeals are in response to adverse determinations for dental services related to benefit design and coverage, medical necessity, and the application of clinical criteria of dental policies
  • Communicate with UnitedHealthcare dental directors regarding appeals recommendation rationales and benefit interpretations with escalated cases/issues when own team is involved
  • Manages and runs appropriate own team meetings to ensure compliance with requirements, i.e. TAT, and other compliance/regulatory requirements.  Also includes the quality oversight of her team and IRR
  • Identify Clinical Appeal trends within appeals data and drive opportunities for increased alignment with vendor’s initial determinations by active feedback and collaboration
  • Actively participate in manager and other team meetings focused on communication, feedback, problem solving, process improvement, staff training and evaluation, and the sharing of program results
  • Provide clinical and strategic input when participating in organizational committees, projects, and task forces

Job Med & Clin Ops-General Mgmt
Primary Location US-TX-Houston
Other Location US-MD-Columbia, US-CA-Santa Ana
Organization CCR/Prior Authorization/MCR
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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