Utilization Management Dental Clinical Lead

Join us for an exciting career with the leading provider of supplemental benefits!

Our Promise
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.

The Utilization Management Clinical Team Lead, you will play a pivotal role in managing and supporting a team of Clinical 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.

Essential Job Functions:

• 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
• Ability to convey information and engaging an audience in a professional setting.
• Oversee and direct utilization management 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 Avesis personnel to improve system efficiency and collaborate on complex barriers that arise.
• Ability to operate in a fast-paced environment under tight deadlines.
• Ensures that the right systems, processes, and measurements are in place to assist with accurate clinical determinations are rendered.

Requirements:

• High School Diploma or Equivalent required
• 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
• Two years …