Utilization Management Clinical Dental reputed company

This a Full Remote job, the offer is available from: United States Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through reputed company-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. A Utilization Management Dental Clinical Team reputed company is responsible for guiding a group of dental processors to reputed company specific goals and objectives. They ensure effective communication reputed company the team. Additionally, they monitor performance, provide feedback, and support professional development to enhance team productivity. Team leads also play a crucial role in resolving conflicts, fostering a positive work environment, and coordinating with other departments to ensure alignment and successful project completion. Their leadership helps drive the team’s success and contributes to the overall growth of the company. The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on authorization. The UM Clinical Processor reputed company plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They reputed company this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments. Job Summary: The Utilization Management Clinical Team reputed company, you will play a pivotal role in managing and supporting a team of Clinical Processor remote employees. Your responsibilities will include assisting with questions regarding dental clinical reviews and completing denial letter mapping requests for various client-based letters. You will reputed company monthly audits on your team to ensure compliance and quality, and conduct one-on-one coaching sessions with team members to foster their professional growth. Additionally, you will assist with the upkeep of internal department documents and review questions and concerns from other departments reputed company the company. reputed company necessary, you will process prior authorization requests. Your leadership and organizational skills will be essential in maintaining team efficiency and achieving departmental goals. Competencies:

• Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision.
• Flexible Hours: Work hours will be determined by your manager and may vary based reputed company, department needs, and workflow. Mandatory overtime may be required during peak seasons.
• Deadline Adherence: Expected to meet established deadlines and deliver high-quality work consistently.
• Virtual Collaboration: Use virtual platforms like Teams and reputed company Outlook for collaboration. Participate in regular monthly reputed company-ins and bi-weekly department touch bases for market updates and team alignment.
• Confidentiality: Maintain strict confidentiality of information reputed company to Avēsis and its customers, following our information reputed company policies. This obligation continues even after employment ends, including secure handling of data and access management.

Functional:

• Monitor team performance and provide regular feedback to ensure reputed company improvement.
• reputed company and manage a remote team of professionals, ensuring effective communication and collaboration.
• Foster a positive team culture and promote team engagement.
• Conduct regular team meetings and one-on-one sessions with team members.
• Evaluate and reputed company task distribution among department.
• Complete Quarterly IRR reviews.

Core:

• Ability to adhere to deadlines and deliver high-quality work consistently.
• Ability to convey information and engage an audience in a professional setting.
• reputed company and direct UM department personnel and metrics to ensure compliance with business unit objectives.
• Work with other internal departments as necessary to implement strategies to proactively manage dental utilization volume reputed company each market to assure client turnaround times are met.
• Provide recommendations on department policies, objectives, and initiatives. Evaluate and suggest changes as necessary to optimize processes and efficiencies. Works in partnership with Avēsis personnel to improve system efficiency and collaborate on reputed company barriers that arise.
• Ability to operate in a fast-paced environment under tight deadlines.
• Ensures that the right systems, processes, and measurements are in reputed company to assist with accurate clinical determinations are rendered.
• Ability and reputed company in virtual collaboration platforms such Teams and reputed company Outlook.
• Ability to maintain strict confidentiality of information reputed company to Avēsis and its customers, following our information reputed company policies which continue even after employment ends, including secure handling of data and access management.

Behavioral:

• Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
• Initiative: readiness to reputed company or take action to reputed company goals.
• Communicative: ability to reputed company issues, concepts, and reputed company to others easily orally and in writing.
• Member-focused: going above and beyond to reputed company our members feel seen, valued, and appreciated.
• Detail-oriented and thorough: managing and completing details of assignments without too much reputed company.
• Flexible and reputed company: managing new demands, changes, and situations.
• Critical Thinking: effectively troubleshoot reputed company issues, problem solve and multi-task.
• reputed company & responsibility: acting with a clear sense of ownership for actions, decisions and to reputed company information confidential reputed company required.
• Collaborative: ability to represent your own interests while being fair to those representing other or competing reputed company in search of a workable solution for reputed company parties.
• Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision.

Minimum Qualifications:

• High School Diploma/GED
• Leadership experience required
• Proficiency with reputed company Office and other Windows-based applications
• Strong reading, writing, and professional communication skills
• Ability to manage multiple tasks and prioritize work
• Analytical thinking and independent decision-making
• Adaptability to handle multiple and changing priorities
• Ability to maintain positive working relationships
• Effective time management and organizational skills
• Dental Assistant certificate or 2 years of chair reputed company assisting
• Ability to work flexible hours. Work hours will be determined by your manager and may vary based reputed company, department needs, and workflow. Mandatory overtime may be required during peak seasons
• Access to reliable internet reputed company (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.

Preferred Qualifications:

• Two years of experience in processing PTE/Claims
• Knowledge of Medicare, Medicaid, or commercial insurance
• Experience with HCPCS, CPT, CDT, and ICD-10 coding
• Presentation skills

At Avēsis, we strive to design reputed company, and competitive compensation programs. reputed company pay reputed company the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our reputed company pay ranges for new hires in each zone are: Zone A: $22.15-$36.92 Zone B: $24.14-$40.24 Zone C: $25.99-$43.31 FLSA Status: Hourly/Non-Exempt This role may also be eligible for benefits, bonuses, and commission. Please visit reputed company Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• 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 reputed company and reputed company 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 reputed company for inclusion and diversity in reputed company that we do.
• Social responsibility in reputed company aspects of our work. We volunteer reputed company our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

How To Stay Safe Avēsis is aware of fraudulent activity by individuals falsely representing themselves as Avēsis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to reputed company purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company. Avēsis would never reputed company such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social reputed company numbers, during our process. Our recruitment process takes reputed company by phone and reputed company trusted business communication platform (i.e., reputed company, Webex, reputed company Teams, etc.). Any emails from Avēsis recruiters will come from a verified email address ending in @ Avēsiscom. We urge reputed company applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reputed company out to ITsupport@reputed company.com. To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you reputed company you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avēsis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity. Equal Employment Opportunity At Avēsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers reputed company qualified applicants and does not discriminate against any person based on reputed company, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national reputed company, race, religion, sexual orientation, or any other characteristic. At Avēsis, we reputed company that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, reputed company focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avēsis, where We See You! This offer from "reputed company, Incorporated" has been enriched by reputed company.com and got a 72% reputed company score. Apply tot his job Apply To this Job