This position works under the direction of the Manager of Dental Operations. The individual in this role will focus on investigating dental potential quality issues, patient safety events, and sentinel/serious reportable events and utilization issues by conducting retrospective chart and focused reviews.
Schedule: Four 9-hour shifts and one 4-hour shift
Monday - Thursday, 7:00 a.m. - 5:00 p.m. and Friday, 7:00 a.m. - 11:00 a.m. CST
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Identifies and reviews medical surgical potential quality issues (PQIs), patient safety issues, sentinel events (SEs) and serious reportable events (SREs) by applying best practice standards of care and clinical experience
- Conducts timely reviews of electronic medical records to meet Optum standards
- Investigations include research, analysis, and preparation of written and verbal case summaries with recommendations for further actions as necessary
- Conducts detailed root cause analysis (RCA) for sentinel events (SEs) and serious reportable events (SREs)
- Ability to organize and maintain current investigation information about cases through documentation in quality of care and quality of service databases
- Communicate in writing to health care providers, track timelines, and perform follow-up as appropriate
- Develops peer review cases and other quality improvement activities identified by deviations from accepted standards of care and monitors corrective action plans to completion
- Assists with quality studies and focused reviews by abstracting medical records for specified criteria
- Participates on quality committees and presents cases to peer review quality management committee
- Collaborate with Dental Director on complex care identified in PQIs / SEs / SREs as needed
- Read, interpret, and document standards/requirements and/or technical specifications
- Work with stakeholders for review/approval of results
- Actively participate in meetings
- Train others on relevant policies, rules, and regulations
- Serve as a resource providing explanation and expertise
- Maintains confidentiality of all activities
- Performs other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- Dental Hygiene Degree or Dental Assistant Diploma and/or applicable military experience
- 3+ years of clinical dental experience
- Proven ability to investigate, analyze, synthesize, and formulate conclusions
- Proven ability to organize quality data in appropriate reporting format
Preferred Qualifications:- Quality experience within a managed care company
- General knowledge of Medicare, VA, TRICARE, or other government health care programs
- Solid computer skills with emphasis on Microsoft Office software
- Proven excellent interpersonal, communication, and writing skills
- Proven to be detail oriented and highly organized with effective time management skills
- Proven ability to work in a fast-paced, dynamic environment
- Proven ability to work in a rapidly changing environment; Being adaptable and flexible
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
