Utilization Management Clinical Dental Processor

Avēsis

Utilization Management Clinical Dental Processor reviewing dental treatment requests for Avesis. Applying clinical judgment and guidelines to ensure patient care needs are met.

Posted 7/16/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $18 - $36 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in dental clinical practices, including reviewing dental x-rays and documentation for medical necessity, while ensuring compliance with client contracts and procedural guidelines. Proficient in managing multiple tasks and maintaining effective communication within a remote work environment.

Highest-signal resume keywords

Dental Clinical ExpertiseReviewing Dental X-RaysMedical Necessity AssessmentMicrosoft Office ProficiencyDental Assistant Certificate

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Dental X-Ray ReviewMedical Necessity ReviewPatient Chart ReviewChair Side AssistingDocumentation Skills

Soft Skills

Professional CommunicationTime ManagementOrganizational SkillsAdaptabilityTask Prioritization

Tools & Technologies

Microsoft OfficeWindows-Based Applications

Certifications & Qualifications

Dental Assistant Certificate

Industry Keywords

Prior AuthorizationUM Procedural GuidelinesMember EligibilityClient Contract Compliance

About the role

Key responsibilities & impact

Leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations.
Perform initial reviews of medical necessity cases, ensuring they comply with member eligibility and the covered services outlined in each client contract.
Conduct reviews of prior authorizations by providers, determining cases of recommended treatment in accordance with Avesis UM procedural guidelines.
Document approval decisions for treatment in accordance with prescribed UM department procedural guidance, and forwards applicable files to the client health plan as required by each contract.
Maintain effective intradepartmental communications and actively participate in routine departmental meetings.

Requirements

What you’ll need

High School Diploma or equivalent required.
2+ years of either Dental Assistant or Dental Hygienist required.
Dental Assistant certificate or 2 years of chair side assisting required.
2 years of experience reviewing dental x-rays, models, photos, and patient charts required.
Proficiency with Microsoft Office and other Windows-based applications.
Strong reading, writing, and professional communication skills.
Ability to manage multiple tasks and prioritize work.
Adaptability to handle multiple and changing priorities.
Effective time management and organizational skills.
Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.

Benefits

Comp & perks

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.