Utilization Management Clinical Dental Processor

The role involves evaluating dental service requests using clinical judgment, applying national criteria, and ensuring compliance with organizational policies. It requires managing a high volume of cases and collaborating with team members to optimize processes.

Location: Remote (US)

Salary: $18.33-$35.84 per hour, depending on geographic pay zone

Responsibilities

• Conduct reviews of prior authorizations by providers, determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or referring the case for professional review.
• Ensure systems, processes, and measurements are in place for accurate clinical determinations.
• Uphold Avesis’ policies and obligations related to UM reviews per client contracts.
• Document approval decisions for treatment and forward files to the client health plan as required.
• Provide recommendations on department policies, objectives, and initiatives; evaluate and suggest process improvements.
• Maintain daily productivity standards for quality and quantity.
• Maintain effective communication within the department and participate in meetings.
• Perform other duties as assigned.

Requirements

• High School Diploma/GED.
• Dental Assistant or Dental Hygienist certification or 2 years of chair side assisting experience.
• 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts.
• Proficiency with Microsoft Office and Windows-based applications.
• Strong reading, writing, and professional communication skills.
• Ability to manage multiple tasks and prioritize.
• Adaptability to changing priorities.
• Effective time management and organizational skills.
• Reliable internet connection (25 MBPS upload/10 MBPS download) and appropriate workspace for remote work.

Benefits

• Competitive compensation package.
• Medical, dental, supplemental health, life, and vision coverage.
• Life and disability insurance.
• 401(k) with company match.
• Tuition assistance, paid parental leave, backup family care.
• Flexible work policies including time off, dress code, and location.
• Employee Resource Groups promoting inclusion and diversity.
• Community volunteering, educational partnerships, sustainability initiatives.

Additional Information

• Mandatory overtime may be required during peak seasons.
• Work hours vary based on location, department needs, and workflow.
• Candidates should exercise caution against fraudulent activity during the application process.