10 days old

Utilization Management Processor

Sacramento, CA 95814
  • Job Code
Position Summary

As a UM Processor you will be responsible for timely and accurate review of dental preservice requests based on a member's eligibility and the requirements of each client contract regarding approval of covered services. You will interact with and help educate our provider network to ensure quality care for our membership.

You are

A self-starter that is proactive and can communicate effectively with internal peers, and external parties (providers, health plan peers.) Can utilize critical thinking to identify when input from Management or Clinical team is required to review incoming requests. Is able to work independently, yet inclusive to team works and tasks, with attention to detail and success at meeting tight turnaround times with accurate output.

    You will
    • Understand and uphold of Avesis' policies and procedures relative to the UM reviews required by each client contract.
    • Conduct reviews of pre-treatment requests by providers to either authorize the recommended treatment, in accordance with Avesis UM procedural guidelines, or to refer the case to a Dental Director or consultant for a professional clinical review.
    • When reviewing preservice requests; if insufficient information is required, perform outreach to providers for correction and resubmission.
    • Document approvals or denials of treatment in accordance with prescribed UM department procedural guidance and forwarding applicable files to the client health plan as required by each contract.
    • Maintain a daily level of productivity in accordance with departmental requirements for production and quality standards.
    • Maintain effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions and routinely held departmental meetings.
    • Other duties as assigned.
    You have
    • 2-3 years' experience in Dental benefit administration
    • High School Diploma or GED is required. Bachelors' or Associate's degree in dental field preferred but not required.
    • Ability to review and understand dental x-rays, models, photos, and patient charts required.
    • Ability to manage multiple tasks, prioritize work and adaptable to change when necessary
    • Excellent written and verbal communication skills required.
    • Proficient windows-based computer skills and skills in navigation and use of MS Office suite applications.

    • Remote


    0% of travel required for this role.

    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

    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.

    About Avesis

    Avesis has been providing essential ancillary benefit solutions since 1978. Since its inception Avesis has developed, administered and refined its offerings to provide clients with best-in-class product choices and services. Today, our programs cover more than 8.5 million members throughout the country. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus.

    The continued upward spiral in health care costs has challenged sponsors, providers and payers of health benefits to deliver high quality care in the most cost-effective manner possible. The Avesis benefits menu has been created to meet that challenge by making available quality essential ancillary benefit services at the lowest possible price while never sacrificing the highest quality of service. Providing outstanding customer service is a top priority, and our core values of accountability, empowerment, excellence, and integrity help us achieve high member and client satisfaction.

    As of January 2016 Avesis is a wholly owned, independent subsidiary of The Guardian Life Insurance Company, a distinction that brings even more capabilities to Avesis. The Guardian is a Fortune 250 mutual insurance company that has put its policyholders and clients above all else for more than 150 years, and it has earned them not only a great reputation but awards and accolades from such authorities as J.D. Power. Adhering to high standards, doing the right thing, and making people count are the founding principles that has kept Guardian financially sound and made them one of the largest insurance companies in the country.

    In January 2017, Premier Access joined the Avesis family. Premier Access has focused on direct state contracts for Medicaid and Chip, specifically in California and Utah. They were one of the original participants in the Chip and Medicaid programs.

    Equal Employment Opportunity

    Avesis is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

    Posted: 2021-10-08 Expires: 2021-11-06
    Sponsored by:
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    Sponsored by:
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