Dental Consultant

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary The Dental Consultant will review WI Medicaid Prior Authorizations based on medical necessity, in accordance with WI Medicaid contracts, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider outreach, and act as a clinical SME (or liaison) for internal entities. This is not a patient facing position. Job Responsibilities • Authorize/deny WI Medicaid prior authorizations. • Enter clinical review decisions into systems. • Evaluate appeals, review documentation/charts, request info, and issue/revise decisions. • Review anesthesia authorization requests for medical necessity. • Review orthodontic/dental claims for handicapping malocclusions. • Communicate authorization outcomes to dentists and members. • Provide provider orientations and support. • Recommend process improvements to management. • Understand WI Medicaid dental benefits, authorization, claims, and denial processes. • Stay updated on state/federal dental regulations and share changes. • Educate provider community and support program management. • Represent Gainwell in provider meetings. • Promote WI Medicaid dental programs. • Review dental cases for fair hearings as needed. Qualifications • Current license to practice dentistry in the state of WI (or license from another state with ability to obtain WI license before start date) • Clinical experience as a credentialed Medicaid dental provider • Experience with prior authorization portals • Proficiency in Microsoft Office (Word, Excel, PowerPoint) • Excellent interpersonal, oral, and written communication skills • Strong organizational, time-management, and analytical skills • Experience analyzing and assessing quantitative and/or qualitative data for complex decision-making • Experience working with various partners or team members toward shared goals • Ability to verbally communicate effectively and interpret policies and procedures • Ability to apply general skills of program management and administration What You Should Expect In This Role • Work Arrangement: Remote within the United States • Position Type: Full-time job Applications for this posting will be accepted until November 25, 2025. The pay range for this position is $115,000.00 - $125,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.