Utilization Management Clinical Processor

Job description

Join us for an exciting career with the leading provider of supplemental benefits! O ur 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. As a Utilization Management Clinical Dental Processor, you will leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations. You will perform initial reviews of medical necessity cases, ensuring they comply with member eligibility and the covered services outlined in each client contract. The UM (Utilization Management) Department supports our clients and company through utilizing clinical criteria to approve or deny a service based on the authorization. The UM Clinical Dental Processor plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. They achieve this by utilizing clinical criteria and evidence-based guidelines to evaluate the necessity and appropriateness of treatments As a Utilization Management Clinical Dental Processor, you will l...