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Direct Reviews Jobs (NOW HIRING)

Amat

Manager, Internal Audit

Austin, TX · On-site +1

$120K - $165K/yr

Review and approve workpapers in AuditBoard/Optro and ensure performance standards are met across the team. * Lead audit planning for operational audits and advisory engagements : direct process ...

Enterprise Engineering

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Concurrent Utilization Review (UR) Nurse

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The UR Nurse collaborates with the Medical Director and clinical leadership for complex cases, denials, and escalated reviews. Key Responsibilities: 1. Concurrent Review & Case Assessment · Conduct ...

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Medical Director - OneHome

Atlanta, GA · On-site

$223.80 - $313.10/hr

The Medical Director reviews and determines whether healthcare services provided by other healthcare professionals align with national guidelines, CMS requirements, Humana policies, clinical ...

Humana

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Coppell, TX · On-site

Review and analyze membership data, identify trends, and communicate findings to the branch Executive Director * Serve as interim Membership Director at branches, overseeing all aspects of membership ...

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Medical Director - OneHome

Phoenix, AZ · On-site

$223.80 - $313.10/hr

The Medical Director reviews and determines whether healthcare services provided by other healthcare professionals align with national guidelines, CMS requirements, Humana policies, clinical ...

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As of Aug 22, 2026, the average hourly pay for direct reviews in the United States is $16.77, according to ZipRecruiter salary data. Most workers in this role earn between $14.90 and $17.79 per hour, depending on experience, location, and employer.
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Director of Clinical Audits and Peer Reviews

North American Dental Group

Pittsburgh, PA

Full-time

Retirement, PTO

Re-posted 29 days ago

North American Dental Group rating

5.7

Company rating: 5.7 out of 10

Based on 31 frontline employees who took The Breakroom Quiz

788th of 891 rated healthcare providers

Job description

Overview
We are looking for a Director of Clinical Audits and Peer Reviews to join our compliance team. This individual will report to the Compliance Director and assist the Compliance Department i Develop and execute a comprehensive clinical audit and peer review strategy aligned with organizational quality and compliance goals.
Responsibilities:
Audit and Compliance Oversight:
  • Conduct internal audits, peer audits, and internal investigations
  • Manage and respond to external audits (insurance companies, regulatory agencies, state dental boards, legal entities)
  • Oversee external insurance payment audits
  • Identify compliance risks and implement corrective action plans
  • Present compliance workflows and documentation standards

Management of Peer Audit Program:
  • Design and select procedures for peer audit review
  • Train and educate auditors on audit protocols and software tools
  • Analyze peer audit results and present findings to clinical leadership
  • Facilitate follow-up and resolution of issues identified during audits

Clinical Review and Risk Management:
  • Participate in clinical review of patient and internal complaints
  • Support investigations involving clinical care and documentation
  • Work with Quality Assurance Committee of the Oral Health Board to address issues identified during clinical reviews
  • Participate in Credentialing committee workflows and meetings for clinical review of re-credentialling matters
  • Serve as expert for state and federal dental practice act regulations, including allowable and prohibited duties by clinical role

Infection Control and Regulatory Compliance:
  • Oversee infection control compliance across supported practices
  • Monitor Direct Unit Water Line (DUWL) testing and weekly spore testing completion
  • Troubleshoot sterilization and testing issues with offices
  • Provide guidance on sterilization, disinfection, and PPE standards

Training and Education:
  • Provide onboarding education for new hires
  • Deliver ongoing training on compliance, infection control, and vendor tools
  • Support adoption of organizational protocols and best practices

Other:
  • Monitor key performance indicators (KPIs) related to audits and infection control
  • Prepare and deliver quarterly reports to executive leadership
  • Collaborate with executive and operational leadership, including the Chair of the Oral Health Board, Vice Presidents of Operations and Clinical Operations, and Regional Directors of Operations.
  • Advocate for company-wide clinical standards

Qualifications:
  • At least eight (8) to ten (10) years experience of in a clinical dental environment
  • Comprehensive knowledge of dental procedures and CDT coding
  • Understanding of insurance billing practices and documentation requirements
  • Knowledge of state Dental Practice Acts and scope of practice for dental healthcare personnel (DHCP)
  • Ability to analyze audit findings and provide actionable recommendations
  • Ability to interpret radiographic images
  • Working knowledge of clinical dentistry across specialties
  • Understanding of standard of care and risk exposure
  • Knowledge of CDC and ADA infection control guidelines
  • Knowledge of OSHA Bloodborne Pathogen (BBP) Standard and workplace safety requirements
  • Understanding of best practices for sterilization, disinfection, and dental operatory setup
  • Knowledge of regulatory compliance requirements and inspection readiness
  • Strong presentation and communication skills
  • Proficiency in Open Dental (OD) reporting and MS Office, especially PowerPoint, Word and Excel
  • Attention to detail; very organized
  • Ability to interact with people at all levels of the corporate structure, prioritize and handle numerous competing demands in a high-volume, fast-paced working environment
  • Ability to work independently and complete job responsibilities without significant oversight

Why You'll Love Working Here
  • Comprehensive Benefits: Including 401(k).
  • Paid Time Off: Competitive PTO that grows with your career.
  • Career Growth: Opportunities for continuing education and development.
  • Exciting Work Environment: A supportive atmosphere that celebrates individuality and teamwork, allowing you to thrive.

Equal Opportunity Employer
We embrace diversity and are committed to creating an inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, ancestry, religion, sex, sexual orientation, gender identity, age, national origin, disability, veteran status, or any other legally protected characteristic.
Ready to Join Us?
Apply today and be part of a team that's revolutionizing dental care!
North American Dental Group-branded practices are independently owned and operated by licensed dentists. The practices receive non-clinical business support services from North American Dental Group, a dental support organization.
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