Utilization Management Clinical Dental Lead

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.

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 Avsis 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 Avsis 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 information related to Avsis and its customers, following our information security policies which continue even after employment ends, including secure handling of data and access management.

Behavioral:

• 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.

Minimum Qualifications:

• 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.

Preferred Qualifications:

• 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

We Offer

• 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.

Equal Employment Opportunity

At Avsis, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic. At Avsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at Avsis, where We See You!