Summary

As a Clinical Screening Review Dental Consultant at Gainwell, you will collect, track, follow up, and analyze referrals of potential fraud, abuse, and substandard quality of care. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Gainwell empowers you to help clients deliver better health and human services outcomes using innovative technology and solutions, enabling you to design your career for growth, new possibilities, and refinement of your valuable skills. Here are the details on this position.

Your role in our mission

• Collect, track, follow up and analyze referrals of potential fraud, abuse, and substandard quality of care.
• 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.
• Determine whether clinical screening examinations should be conducted and/or whether additional patient records are required for review in cases of potential fraud, abuse and/or quality of care.
• Collaborate with the clinical screening department to coordinate screening appointments and train/calibrate clinical screening dentists within the Program.
• Create, edit and present results of clinical screening and patient records findings as a part of written reports and verbal presentations.

What we're looking for

• A minimum of ten (10) years of experience as a dentist.
• Must hold an active CA dental license, in good-standing and free of any suspensions or sanctions from Federal, State or local jurisdictions.
• Proficiency in creating, querying, and analyzing reports.
• Strong writing skills with the ability to convey data in a clear and actionable manner.
• Demonstrated expertise and knowledge of Medi-Cal Dental criteria and clinical screening preferred.

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off (vacation, sick time, holidays) benefits start on day 1 of employment.
  • Further discussed during new hire orientation only.
• Company match 401K and other benefits available within months of starting.
  • Further discussed in new hire orientation only.
• Company provided computer and other equipment if needed to perform this role.
  • All equipment is to remain in our office.
• Monday through Friday work schedule.
• Our office hours in Roseville, CA are 8 AM to 5 PM Monday through Friday in the office.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

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This position is intended for pipelining. We will accept applications on an ongoing basis.