Utilization Management Clinical Dental Lead

Avesis

4d•$22 - $43•Remote

About The Position

Through skill-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 Lead is responsible for guiding a group of dental processors to achieve specific goals and objectives. They ensure effective communication within 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 Lead plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They achieve this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments. Job Summary: The Utilization Management Clinical Team Lead, 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 perform 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 within the company. When necessary, you will process prior authorization requests. Your leadership and organizational skills will be essential in maintaining team efficiency and achieving departmental goals.

Requirements

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 on location, 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 Microsoft Outlook for collaboration. Participate in regular monthly check-ins and bi-weekly department touch bases for market updates and team alignment.
Confidentiality: Maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies.
Ability to adhere to deadlines and deliver high-quality work consistently.
Ability to convey information and engage an audience in a professional setting.
Ability to operate in a fast-paced environment under tight deadlines.
Ability and skill in virtual collaboration platforms such Teams and Microsoft Outlook.
Ability to maintain strict confidentiality of information related to Avēsis and its customers, following our information security policies which continue even after employment ends, including secure handling of data and access management.
Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth.
Initiative: readiness to lead or take action to achieve goals.
Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing.
Member-focused: going above and beyond to make our members feel seen, valued, and appreciated.
Detail-oriented and thorough: managing and completing details of assignments without too much oversight.
Flexible and responsive: managing new demands, changes, and situations.
Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task.
Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required.
Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.
Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision.
High School Diploma/GED
Leadership experience 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
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 side assisting
Ability to work flexible hours. Work hours will be determined by your manager and may vary based on location, department needs, and workflow. Mandatory overtime may be required during peak seasons
Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.

Nice To Haves

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

Responsibilities

Assist with questions regarding dental clinical reviews
Complete denial letter mapping requests for various client-based letters
Perform monthly audits on your team to ensure compliance and quality
Conduct one-on-one coaching sessions with team members to foster their professional growth
Assist with the upkeep of internal department documents
Review questions and concerns from other departments within the company
Process prior authorization requests
Monitor team performance and provide regular feedback to ensure continuous improvement
Lead 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 oversee task distribution among department
Complete Quarterly IRR reviews
Oversee 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 within 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 complex barriers that arise
Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations are rendered

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. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.