Utilization Management Clinical Processor

📋 Description

• • Join Avesis Incorporated as a Utilization Management Clinical Dental Processor, where you will apply your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations in a remote, USA-based role.
• • Your day-to-day responsibilities include conducting initial reviews of service requests, determining compliance with member eligibility and covered services, completing 13 to 18 cases per hour, reviewing patient histories, importing documentation into internal systems, and providing recommendations to optimize processes.
• • You will be part of the Utilization Management Department, which ensures healthcare services are appropriate, efficient, and effective by applying clinical criteria and evidence-based guidelines, supporting clients and company operations through accurate prior authorization decisions.
• • In this role, you will develop expertise in dental utilization management, strengthen clinical decision-making, gain experience with healthcare regulations and insurance systems, and contribute to process improvements while working autonomously in a collaborative, mission-driven environment.