Clinical Reviewer, Dental Hygienist

A bit about this role:

• A licensed dental hygienist will play a vital role within Devoted Health's Clinical Operations team by performing first-level clinical reviews of dental claims and pre-treatment estimates using established clinical guidelines, policies, and delegated authority. This position ensures accurate, timely, and compliant utilization management while supporting high-quality, compassionate care and strong relationships with dental providers.

Schedule:

The position follows a five-day, eight-hour work schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM-8:00 PM ET and will include weekend and Holiday rotation coverage.

• First-Level Clinical Evaluation:
  Review assigned dental claims and pre-treatment estimates requiring clinical evaluation, approving claims that meet clinical, contractual, and documentation requirements.
• Documentation & Image Review:
  Evaluate radiographs, dental charting, narratives, treatment records, and claim histories using evidence-based guidelines and clinical expertise.
• Case Referral & Coordination:
  Refer complex cases, potential denials, or adverse benefit determinations to Dental Advisors or designated clinical authorities for final determination (the Dental Hygienist Clinical Reviewer does not deny authorizations).
• Documentation & System Entry:
  Identify required documentation for clinical review, clear processing instructions, and document review findings accurately in claims systems.
• Coding & Policy Application:
  Consistently apply ADA CDT coding knowledge, dental terminology, clinical documentation standards, and contractual provisions.
• Quality & Escalation:
  Identify and elevate unusual practice patterns, utilization trends, potential fraud, waste, or abuse concerns, policy gaps, or workflow issues.
• Cross-Functional Collaboration:
  
  Collaborate with Dental Advisors, Claims, Provider Relations, and team leads to support smooth operations and constructive provider communications.
• Compliance:
  Maintain full compliance with HIPAA, privacy standards, organizational policies, and regulatory requirements.

• 5+ years of clinical experience as a dental hygienist in a private practice or comparable dental healthcare setting. Dental claims review or utilization management experience is a plus.
• Active Registered Dental Hygienist (RDH) license or relevant clinical dental credential in good standing.
• Strong working knowledge of ADA CDT coding, dental terminology, dental procedures, and clinical documentation.
• Demonstrated ability to read and interpret dental radiographs, charting, clinical narratives, and treatment records.
• Excellent analytical, organizational, communication, and problem-solving skills with high attention to detail.
• Proficiency with claims-processing systems, electronic health/dental records, and standard digital tools.
• Experience with technology-enabled workflow improvements, particularly with AI/LLM tools.

• Prior experience in dental insurance claims review, utilization management, or health plan clinical operations, ideally within a Medicare Advantage or managed care setting.

#LI-remote

$58,000 - $75,000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above;
  Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....

* Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.