Sr. Clinical Dental Advisor, DentaQuest

Job Description

: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. The opportunity: The Sr. Clinical Dental Advisor acts as the primary professional authority on service authorizations and medical necessity determinations. This role ensures that dental services requested by providers comply with state and federal Medicaid regulations, evidence-based standards and dental plan policies. The Sr. Clinical Dental Advisor maintains the highest level of productivity and quality in making service authorization decisions. How you will contribute:

Prior Authorization (PA) review and authorization: Evaluate dental requests (including x-rays and clinical notes) for appropriateness, completeness, and adherence to Oregon Administrative Rules (OARs); make service authorization decisions.

Specialty Referral Review: Evaluate requests from General Dentists for specialty ser...