**Band 3** **Job Family: Quality Review** **Quality Clinical Dental Hygienist Lead Analyst** Required to be certified in a clinical based specialist to perform clinical review of medical records as a Dental hygienist. Under the supervision of the QOC Manager, the Dental Hygienist conducts clinical reviews and investigation of potential quality of care dental issues in a timely, and efficient manner. The Dental Hygienist is responsible for conducting quality improvement/management activities in accordance with state and federal regulatory requirements, including, but not limited to, Centers for Medicare and Medicaid Services (CMS), State and National Committee for Quality Assurance (NCQA). Experience level: 2-4 years. **Major Duties and Responsibilities:** + Reviews and investigates potential quality of care (QOC) dental cases, which include, but are not limited to, adverse events, critical incidents and never events. + Coordinates dental record requests, as appropriate, and reviews dental records to complete investigation. + Works in collaboration with MME, market medical directors and QOC Manager in the investigation of quality-of-care dental issues. + Monitors quality of care dental issues and develops corrective action plans for areas of concern as applicable. + Reviews and monitors high-risk, high-volume, and unusual events concurrently and retrospectively as they occur. + Manages the occurrence reporting system ensuring timely and appropriate incident investigation, remediation and documentation of dental cases. + Prepares summary of findings, assigns severity levels to case (LEVEL 0-I), when appropriate, and prepares resolution letter to customer. + Prepares and sends corrective action plans in collaboration with Medical Directors and QOC Unit manager as applicable. + Prepares case studies for presentation to National Physician Advisory Committee (NPAC). + Assists with preparation of and may present quarterly reports to Corporate Quality Improvement Committee (CQIC) and NPAC. + Maintains performance against established targets. + Participates in inter-rater reliability testing to ensure consistency of reviews led by Registered Nurses quarterly. + Maintains knowledge of policies and procedures and assures team performs assigned duties in accordance with applicable regulatory requirements, State and accreditation standards. + Performs other job-related duties as required and referred by QOC Unit manager within your scope of practice. **Core Competencies and Skill Requirements:** + Strong knowledge of Dental disease processes and usual methods of treating with current trends up to surgical interventions. + Thorough knowledge of dental terminology and commonly used equipment. + Ability to effectively evaluate dental records for appropriateness of care/treatment courses. + Ability to assess and judge the clinical performance of Dentist and other health professionals. + Strong analytical, assessment and problem-solving skills. + Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards of care pertaining to dental disease management. + Intermediate skills in Word, PowerPoint, Excel, and Outlook with basic ability to enter data into and navigate through a database. + Maintains confidentiality of all sensitive documents, records, discussions and other information generated in connection with dental quality-of-care activities. + Self-directed and able to work independently. Uses appropriate judgment to seek assistance and ask questions as appropriate. + Keeps QOC Manager updated on overall activities, issues identified, and actions to address issues. + Strong attention to detail and work accuracy. **Required/Preferred Education, Experience, and Training:** + Current, active and unrestricted Certification as a Dental Hygienist. + Two to four years of clinical experience working under limited supervision preferred. + Experience with CMS, NCQA standards, HEDIS, CAHPS, and quality management preferred. + Knowledge/experience in the Medicare/Medicaid industry preferred. + Strong project management, research and analytical skills preferred. Part-time: 20 hours per week Work Shift WORKDAY Timekeeping (United State of America) Primary Location: Work at home – part-time If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 50,600 - 84,300 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group . **About Cigna Healthcare** Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. _Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws._ _If you require reasonable accommodation in completing the online application process, please email:_ _SeeYourself@cigna.com_ _for support. Do not email_ _SeeYourself@cigna.com_ _for an update on your application or to provide your resume as you will not receive a response._ _The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State._ _Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._