[Hiring] Utilization Management Clinical Processor @LE701 Avesis, LLC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As a Utilization Management Clinical Dental Processor, you will 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 compliance with member eligibility and covered services outlined in each client contract. • Utilize clinical criteria to approve or deny services based on authorization. • Evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision. • Apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies. • Complete 13 to 18 cases per hour to meet client standards and contractual obligations. • Complete clinical scripts, review patient histories, and import supporting documentation into the internal system. • Work hours may vary based on location, department needs, and workflow; mandatory overtime may be required during peak seasons. Qualifications • High School Diploma/GED • Dental Assistant or Dental Hygienist required • Dental Assistant certificate or 2 years of chair side assisting • 1-2 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. Requirements • X-Ray certification is highly preferred. • Knowledge of Medicare, Medicaid, or commercial insurance. • Experience with HCPCS, CPT, CDT, and ICD-10 coding. Benefits • 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 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.