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COMPLETE Oral Health Coordinator - AZ - Work from home

2 days ago


Job Opportunity Details


Full Time


Not Telling

Work from home


Weekly Working Hours

Not Telling


Not Telling

Working Location

Work At Home-Arizona, AZ - Work from home, United States   [ View map ]

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Develop, implement, support, and promote dental health care strategies and programs that drive improvements in the delivery of quality dental care for all Mercy Care Members. The Dental Plan strategy includes the development, monitoring, and evaluation of annual dental plans for ACC-RBHA, ALTCS, DDD and DCS CHP lines of business.

Under the general supervision of the Director of Medical Management Clinical Operations and working closely with Mercy Care’s Dental Director, this position provides clinical expertise to support daily operations:

  • Monitor dental service utilization trends for multiple lines of business and establishes action plans to reduce barriers and improve access to care

  • Maintain dental workplans and report quarterly and annual outcomes  

  • Formulate and implement strategies for the organization/unit to meet KPM's (key performance measures)

  • Develop the annual dental plan strategy to address member needs across the continuum of care

  • Drive clinical innovations that integrate and connect health care data and clinical quality

  • Provide clinical expertise and business direction in support of dental programs through participation in clinical team activities and serve as technical professional and business resource

  • Render consistent opinions on emerging dental trends, utilization review, standards of care and develop, implement, and evaluate policies and procedures, which meet business needs

  • Analyze utilization data to identify opportunities for quality improvement, cost containment and to positively influence practice patterns or benefit plan designs and collaborate such with internal and external partners

  • Serve as a dental clinical consultant that supports internal teams improve coordination of dental care for members with SHCN

  • Provides clinical support for medical prior authorization staff and medical directors for special circumstances requiring medical exceptions for necessary oral health services.

  • Represent Mercy Care for community outreach and dental education initiatives.

Required Qualifications

• 3+ years of dental hygienist experience required.

• 3+ years of dental coding experience required.

• Licensed Dental Hygienist.

Preferred Qualifications
• Bi-lingual in English/Spanish preferred.

• Experience collecting and processing insurance preferred.

• Experience with prior authorization experience preferred.

• Bachelor's degree preferred.

Associate's degree.

Pay Range

The typical pay range for this role is:

$28.25 - $60.50

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. 

More Information

Application Details

  • Organization Details
    4004 Aetna Medicaid Administrators

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