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

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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/GED
• Dental Assistant certificate or 2 years of chair side assisting
• 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
• Two years of experience in processing PTE/Claims Preferred
• Knowledge of Medicare, Medicaid, or commercial insurance Preferred
• Experience with HCPCS, CPT, CDT, and ICD-10 coding Preferred
• Presentation skills Preferred

FLSA Status: Hourly/ Non-Exempt

National Hourly Rate Range: $22.15 - $34.64

How to stay safe:

Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases  (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.

Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulen