Commercial and Government Benefits
Utilization Management Clinical Dental Processor
Location
United States
Posted
2 days ago
Salary
$18 - $35 / hour
Seniority
Mid Level
Job Description
Utilization Management Clinical Dental Processor
Avēsis
• Leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations. • Perform initial reviews of medical necessity cases, ensuring they comply with member eligibility and the covered services outlined in each client contract. • Conduct reviews of prior authorizations by providers, determining cases of recommended treatment in accordance with Avesis UM procedural guidelines. • Document approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract. • Maintain effective intradepartmental communications and actively participate in routine departmental meetings.
Job Requirements
- High School Diploma or equivalent required.
- 2+ years of either Dental Assistant or Dental Hygienist required.
- Dental Assistant certificate or 2 years of chair side assisting required.
- 2 years of experience reviewing dental x-rays, models, photos, and patient charts required.
- Proficiency with Microsoft Office and other Windows-based applications.
- Strong reading, writing, and professional communication skills.
- Ability to manage multiple tasks and prioritize work.
- Adaptability to handle multiple and changing priorities.
- Effective time management and organizational skills.
- Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.
Benefits
- Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
- Life and disability insurance.
- A great 401(k) with company match.
- Tuition assistance, paid parental leave and backup family care.
- Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
- Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
- Employee Resource Groups that advocate for inclusion and diversity in all that we do.
- Social responsibility in all aspects of our work.
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