Utilization Management Clinical Dental Processor

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Avēsis

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare Insurance • Wellness

Avēsis is a company dedicated to providing comprehensive specialty benefits focused on improving access, equity, and health outcomes. Specializing in dental and vision plans, Avēsis offers flexible, affordable, and outcome-focused oral health benefits as well as vision plans that connect eye health to overall well-being. With over 40 years of experience, Avēsis is committed to personalized care and building community health networks to service government partners, commercial providers, employers, and brokers. Avēsis operates as a wholly owned subsidiary of Guardian, and leverages tailored network and product solutions to deliver accessible quality care to members, while also administering Medicaid, Medicare, and other essential benefits programs.

📋 Description

• 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.

🎯 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.