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Posted: Sunday, September 3, 2017 1:47 AM

/ 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 will drive the future of health care . This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company. *State Dental Director**Location:* Any US location preferably Eagan, MN 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. * Previous experience in utilization review/utilization management and/or fraud, waste, & abuse strongly preferred.**/ 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 antheminc.com/careers. EOE. M/F/Disability/Veteran. / **Job** *Medical* **Title:** *DDS or DMD Dental Director - Any Location - 131202* **Location:** *ohio-Youngstown* **Other Locations:** *CA-San Diego, NY-Albany, CA-Thousand Oaks, MO-St. Louis, GA-Atlanta, VA-Richmond* **Requisition ID:** *131202* Company Description:We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company. At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans. One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.We offer a broad range of medical and specialty products.Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our co

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• Location: Toledo

• Post ID: 49071932 toledo
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