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Licensed Orthodontic Consultant (1318)

Orthodontics | New Castle, DE | Contract

Job Description
Licensed Orthodontic Consultant
Work Location: New Castle, DE

Job Duties/Responsibilities/Functions (including but not limited to)
• This contract provides for consultative services to review and approve or deny requests for orthodontic treatment submitted to the Delaware Medical Assistance Program (DMAP).
• By reviewing each referred case, the consulting orthodontist will determine whether an individual meets the DMAP established criteria for the service requested.
• The consulting orthodontist will be provided with necessary imaging and diagnostic models to fully evaluate the orthodontic necessity.
• Additional information can be requested by the consulting orthodontist as needed to determine orthodontic necessity/eligibility.
• Response in a timely manner to all clinical inquiries from oral health providers, State Medicaid administrators, and the State Dental staff. The Contractor may use telephone, fax, e-mail, or written correspondence to communicate with these stakeholders.
• Maintain a database of all submitted cases; Update the database on an ongoing basis, to reflect the existing workload; Make this database available to the State on an ongoing basis.
• Following each review session, complete the DMAP-provided inventory sheet.
• Maintain patient and provider confidentiality as required under HIPAA.
• Provide case summaries and other necessary documentation to assist the Dental Administrator and Dental Director in preparing for Fair Hearings; completed at no additional cost to the contract.
• Be available for consultation with DMMA staff (and/or their designees) regarding program policy, dental standards of care, and other related clinical matters.