Dental Utilization Management Processor

Job Summary

Evaluating service requests and determining treatment appropriateness, the full-time remote Utilization Management Clinical Dental Processor will leverage clinical judgment to assess dental cases, complete clinical scripts, and maintain compliance with organizational policies while managing a productivity standard of 13 to 18 cases per hour.

Key responsibilities

• Conduct reviews of prior authorizations and determine treatment recommendations in accordance with procedural guidelines
• Document approval decisions and forward applicable files to client health plans as required
• Maintain productivity levels in accordance with departmental standards and participate in routine departmental meetings

Required qualifications

• High School Diploma/GED
• Dental Assistant or Dental Hygienist required
• 1-2 years of experience reviewing dental x-rays, models, and patient charts
• Proficiency with Microsoft Office and other Windows-based applications
• Access to a reliable internet connection and an appropriate workspace for remote work