Dental Utilization Management Processor

Job Summary

Leveraging dental clinical expertise, the full-time Utilization Management Clinical Dental Processor will review dental x-rays and documentation to assess medical necessity for prior authorizations, ensuring compliance with client contracts while working remotely.

Key responsibilities

• Conduct initial reviews of medical necessity cases and document approval decisions in accordance with procedural guidelines
• Utilize clinical criteria to evaluate service requests and ensure compliance with member eligibility and covered services
• Maintain productivity standards by completing 13 to 18 cases per hour while adhering to departmental quality requirements

Required qualifications

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