Remediation/Surveillance Utilization Dental Consultant - Roseville, CA

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' Remediation / Surveillance Utilization Dental Consultant is responsible for supporting activities to support and monitor providers on prior authorization or special claims review (PA / SCR) remediation to detect and reduce 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
• Communicate with and support dental providers placed on remediation activities
• Monitor providers on PA / SCR remediation, including processing of treatment authorization request (TAR) and claims processing for providers on remediation
• Work closely with the CA Department of Health Care Services to identify and review provider training and recommendations for provider graduation from compliance review / remediation.
• Create, edit and present results of remediation activities of surveillance and utilization review findings via written report and verbal presentations

What we're looking for

What you should expect in this role

Monday through Friday work schedule (40 hours per week).

24MBS download and

8 MBS upload .  Greater speeds will of course provide better performance.

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The pay range for this position is $116,100 - $165,900 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.

Salary : $116,100 - $165,900