Dentist - Medical Review - Contract Position - Louisiana
Qlarant, Inc., is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country.
Qlarant has an exciting opportunity for a Louisiana licensed, Board certified Dentist to perform:
- Medical Review
- Support of Review Determinations
- Testimony regarding review results
Candidates should be actively practicing or recently (less than three years) retired. A background in Pediatric Dentistry with Medicaid experience and a Level II or III Sedation Permit is preferred. A background in general Dentistry with Medicaid experience is acceptable as well.
Please Note: This is a contractual / as needed position. There are no guaranteed hours.
It is preferred that the selected candidate reside in Louisiana. Candidates residing in other states that possess a Louisiana Dental license are welcome to apply. Qualified candidates should be willing and able to support review determinations during the appeals process including court testimony.
Essential Duties and Responsibilities
While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned.
- Provides clinical information to teams
- Medical Review responsibilities may include:
- Physician peer reviews
- Supporting determinations during appeal process, including depositions and other testimony
- Criteria development and assessment
- Correspondence regarding review determination
- Professional Relations may include:
- Interfacing with external organizations including state and federal agencies
- Health Care Quality Improvement/Assurance may include:
- Leading and/or participates in quality improvement projects as needed
- Providing clinical input to specific projects as required by the organization or contractors
- Supporting project managers or teams with specific collaborative projects as needed
- Maintaining working knowledge of current quality improvement issues and tools
Supporting our Unified Program Integrity Contractors team for the Southwestern Jurisdiction (UPIC SW), you can contribute to our efforts to make a positive difference in the future of our nation's healthcare programs. Our UPIC SW team identifies and investigates fraud, waste and abuse in the Medicare and Medicaid programs covering 7 states.
- Doctor of Dental Surgery (D.D.S) or Doctor of Dental Medicine (D.D.M.) with at least five years of dentistry experience.
- Board certification as a Dentist
- Pediatric dentist with Medicaid experience and level II or III sedation permit preferred; will consider a general dentist with Medicaid experience
- Actively practicing dentist preferred. Will consider recently a retired dentist if retired less than 3 years
- Medical Review experience preferred
- Must be computer literate with Microsoft Word and Outlook skills at a level needed to complete assignments in a timely and professional manner
- Must be willing and able to testify regarding review results
Certificates, Licenses, Registrations: Valid, current, active, and unrestricted Louisiana Dental license.
Travel Requirements: May require occasional overnight and/or local travel for court testimony. Must be willing to travel in accordance with company and contract needs.
Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.