Anthem DDS or DMD Dental Director -Any Location, 128689 in Louisville, Kentucky

/Your Talent. Our Vision./At Anthem, Inc.,it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for maintenance of dental Quality Assurance.

Primary duties may include, but are not limited to:

  • Works in tandem with utilization management (UM) department to review quality of care complaints and grievances and appeals.
  • Expert utilization management/utilization review (UR) skills for review of clinical information related to claims for benefit determination
  • Discusses adverse determinations with providers when necessary and upon request
  • Applies clinical criteria/guidelines to utilization review process when appropriate
  • Participates on internal committees as a subject matter expert in all clinical processes including, but not limited to: utilization management, quality improvement, clinical policy, fraud, waste and abuse
  • May participate in the Dental Quality Improvement Committee
  • Makes recommendations for provider corrective actions and works with the data analytics and dental Special Investigations Unit (SIU)
  • Refers providers of interest to dental SIU including providing clinical opinions
  • Provides education to staff in achieving compliance for all state and federal regulations that pertains to the delivery of dental services
  • Provides dental education to staff on an as needed basis

  • Requires a DDS or DMD from an American Dental Association accredited dental school; minimum of 5 years experience as a dental insurance consultant/director or similar experience; or any combination of education and experience, which would provide an equivalent background.

  • Current active unrestricted license to practice dentistry in applicable state(s) required.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran./

Job Medical

Title: DDS or DMD Dental Director -Any Location, 128689

Location: KY-Louisville

Requisition ID: 128689