Dental Consultant- California

About the Role

Gainwell Technologies Dental Consultants apply their clinical expertise to review, approve, and/or deny dental treatment authorization requests and claims in accordance with California Department of Health Care Services (DHCS) Medi‑Cal Dental policies.

Responsibilities

• Review claims, Treatment Authorization Requests (TARs), and related documentation for California Medi‑Cal members to support adjudication decisions, ensuring compliance with Medi‑Cal Dental policies and procedures.
• Collaborate within a team of dental consultants to manage a shared workload of claims requiring professional dental expertise.
• Assist with the training and onboarding of new dental consultants by providing guidance, mentorship, job shadowing opportunities, and coaching.
• Provide support to fellow dental consultants by reviewing complex cases and offering second opinions, including collaboration on cases involving special‑needs populations served by the Medi‑Cal Dental Program.
• Support other departments as requested, including Claims Processing and Operations, Provider and Member Services, Grievances and Appeals, Human Resources, Quality Management, Peer Review, and Clinical Screening Dentist evaluations.

Requirements

• Minimum of ten (10) years of hands‑on clinical experience practicing dentistry in a general dentistry setting or a recognized dental specialty.
• Active (non‑expired) license to practice dentistry in California, in good standing and free of any suspensions, restrictions, or sanctions.
• Minimum of two (2) years of experience working within an organization that provides Medi‑Cal Dental services.
• Demonstrated expertise and in‑depth knowledge of Medi‑Cal Dental criteria, policies, and program requirements.
• Prior experience with adjudication and claims processing for the California Medi‑Cal Dental Program is preferred but not required.

Qualifications

• California residency required.
• Full‑time, exempt salaried position (40 hours per week).
• Remote position with occasional onsite presence required at the Roseville, CA office, based on business needs.
• Employee must maintain Gainwell Technologies as their sole full‑time employer.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Access to leadership and technical development academies.

Schedule

Full‑time (40 hours per week) with remote work flexibility and occasional onsite requirements.