SHP Dental Director

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Company: Samaritan Health Services

Location: Corvallis, OR 97330

Description:

  • JOB SUMMARY/PURPOSE
    • Responsible for utilization management of the dental benefit for Samaritan Health Plans Dental and final adjudication of appeals recommendations or decisions for the Coordinated Care Organization. Reviews referrals, authorizations, and appeals to determine if they meet clinical, contractual, OAR, and/or other applicable guidelines in administering the dental benefit for Samaritan Health Plans Dental members. May also review and issue final adjudication of appeals on behalf of Samaritan Health Plans CCOs or make final adjudication recommendations.
  • DEPARTMENT DESCRIPTION
    • Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
  • EXPERIENCE/EDUCATION/QUALIFICATIONS
    • Doctor of Dental Medicine (DMD) degree or a Doctor of Dental Surgery (DDS) degree issued by a college or university accredited by the American Dental Association required.
    • Current unrestricted license to practice dentistry in Oregon required.
    • Five (5) years clinical experience required.
    • Experience with OHP members, providers, and benefits preferred.
  • KNOWLEDGE/SKILLS/ABILITIES
    • Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
    • Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
    • Ability to complete review and make determinations on required timelines. Ability to accommodate work that is sporadic in nature and may require quick turnaround of deliverables.
  • PHYSICAL DEMANDS
    • Rarely
      (1 - 10% of the time)
      Occasionally
      (11 - 33% of the time)
      Frequently
      (34 - 66% of the time)
      Continually
      (67 - 100% of the time)
      CLIMB - STAIRS
      LIFT (Floor to Waist: 0"-36") 0 - 20 Lbs
      LIFT (Knee to chest: 24"-54") 0 - 20 Lbs
      LIFT (Waist to Eye: up to 54") 0 - 20 Lbs
      CARRY 1-handed, 0 - 20 pounds
      BEND FORWARD at waist
      KNEEL (on knees)
      STAND
      WALK - LEVEL SURFACE
      ROTATE TRUNK Standing
      REACH - Upward
      PUSH (0 - 20 pounds force)
      PULL (0 - 20 pounds force)
      SIT
      CARRY 2-handed, 0 - 20 pounds
      ROTATE TRUNK Sitting
      REACH - Forward
      MANUAL DEXTERITY Hands/wrists
      FINGER DEXTERITY
      PINCH Fingers
      GRASP Hand/Fist

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