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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.

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 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. 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 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.

Core:

• Ability to adhere to deadlines and deliver high-quality work consistently.
• Ability to convey information and engage an audience in a professional setting.
• 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.
• 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.
• Ability and skill in virtual collaboration platforms such Teams and Microsoft Outlook.
• Ability to maintain strict confidentiality of informat