Aetna Dental Consultant in Jacksonville, Florida
Req ID: 49034BR
This is a Part-time/hourly Oral Surgeon Dental Consultant position. The Dental Consultant conducts clinical claim reviews and provides input and oversight for dental clinical policy implementation and participates in the development, implementation, and evaluation of clinical/dental programs.
Responsible for predetermination reviews and reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Expands Aetna's dental programs to address member needs across the continuum of care. Supports the Dental Claims staff ensuring timely and consistent responses to members and providers. Provides clinical expertise and business direction in support of dental programs, through participation in clinical team activities. Render consistent opinions on emerging dental trends, utilization review, dental plan coverage, network management, claims policy and standards of care and develop, implement, and evaluate policies and procedures, which meet business needs Perform special investigations claims reviews and reviews of complaints/appeals
BACKGROUND/EXPERIENCE: DMD or DDS degree in addition to professional licensure and Board certification in Oral & Maxillofacial Surgery; Required 10 years of Oral & Maxillofacial Surgery experience in a Dental Health Care Delivery System, e.g., Clinical Practice and Health Care Industry; Required
The minimum level of education required for candidates in this position is a Doctorate.
LICENSES AND CERTIFICATIONS
Dental/Licensed Dentist (DMD or DDS) ; Required
Board certification in Oral & Maxillofacial Surgery; Required
This position will require an In Office presence in Jacksonville, Florida. There may be opportunities for telework in the future.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care