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Registered Dental Hygienist, Clinical Fair Hearings - Brooklyn, NY

UnitedHealth Group


Location:
Brooklyn, NY
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1774010
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Job Details


Registered Dental Hygienist, Clinical Fair Hearings - Brooklyn, NY(Job Number:725520)
Description

In collaboration with and supervision by the Registered Dental Hygienist (RDH) Manager and the National Dental Director, the Fair Hearing Appeals RDH, is responsible for providing recommendations for clinical case outcomes determined by a licensed dentist.  The Fair Hearing (FH) RDH will attend and represent UnitedHealthcare (UHC) in all Brooklyn Court appearances. 
 
Primary Responsibilities: 
  • Work as part of an integrated team of the QA team, other functional areas, and members of the UHC C&S Medical appeals staff
  • Receive, gather information, and prepare Fair Hearing packets for the NY C&S Health Plan and others as appropriate for clinical and administrative determinations
  • Communicate with UHC RDH manager and dental directors regarding Fair Hearings
  • Works directly with DDS making the final determination on Clinical cases
  • Attends the Brooklyn Fair Hearings in person and represents UHC.  Counsels and educate members and providers regarding adverse determinations and plan benefits 
  • Actively participate in team meetings focused on communication, feedback, problem solving, process improvement, and staff training as appropriate
  • Participating in organizational committees, projects, and task forces as appropriate
  • Prepare Evidence packets; collect & compile supporting documentation to support adverse determination and make 3 copies for hearing
  • Prepare waiver packets
  • Travel to & Present evidence packet at Fair Hearings in court
  • Receive Decision & Orders (D&O) from NYS and update outcome status in tracking log
  • Review D &O; Coordinate implementation of directives from Administrative Law Judge
  • Receive compliance inquiries from NYS requesting proof of compliance with D&O
  • Coordinate and compile proof of compliance and draft responses to NYS DOH
  • C&S Dental Medicaid Fair Hearings in-person representation in the Brooklyn Courthouse, as required by the State - This will reduce dental consultant costs, and allow for increased oversight and management of the revised and improved process

Job MEDICALMGMT CLINICAL REVIEW
Primary Location US-NY-Brooklyn
Other Location 
Organization CCR/Prior Authorization/MCR
Schedule Full-time
Number of Openings 1
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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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