Clinical Reviewer, Dental Hygienist

Job Description

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.

Your Responsibilities and Impact will include:

• 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 escalate 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.

Required skills and experience:

• 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.

Desired skills and experience:

• 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

Salary range: $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.

Our Total Rewards package includes:

• 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.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.