Utilization Management Clinical Supervisor - Dental

Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through reputed company-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. 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 Supervisor plays a crucial role in ensuring that healthcare services provided to members are appropriate, efficient, and effective. A Utilization Management Supervisor is responsible for guiding a group of employees to reputed company specific goals and objectives. They ensure effective communication reputed company the team. Additionally, they monitor performance, provide feedback, and support professional development to enhance team productivity. Supervisors also play a crucial role in resolving conflicts, fostering a positive work environment, and coordinating with other departments to ensure alignment and successful project completion. Their leadership helps drive the team's success and contributes to the overall growth of the company. As a Utilization Management Supervisor, you will play a pivotal role in managing and supporting a team of remote employees. Your responsibilities will include overseeing Prior Authorizations, and/or Retrospective Review that the Clinical Review team completes to ensure appropriate care to members. You will supervise day-to-day activities of Utilization Management team including assisting with questions, reviewing client-based letters, conducting monthly client reporting, and analyzing trends of UM reports. You will reputed company monthly audits on your team to ensure compliance and quality and conduct one-on-one coaching sessions with your reputed company to foster their professional growth. Also, you will help with upkeeping internal department documents and review questions and concerns from other departments reputed company the company. reputed company necessary, you will reputed company testing and train your staff members. You will process prior authorization requests reputed company necessary to meet turnaround times. Your leadership and organizational skills will be essential in maintaining team efficiency and achieving departmental goals. Competencies: • Self-Motivation & Organization: Must be self-motivated and highly organized with the ability to work autonomously without direct supervision. • Flexible Hours: Work hours will be determined by your manager and may vary based reputed company, department needs, and workflow. Additional hours reputed company of normal shifts may be required. • Deadline Adherence: Expected to meet established deadlines and deliver high-quality work consistently. • Virtual Collaboration: Use virtual platforms like Teams and reputed company Outlook for collaboration. Participate and conduct monthly/quarterly reputed company-ins and bi-weekly department touch bases for market updates and team alignment. • Confidentiality: Maintain strict confidentiality of information reputed company to reputed company and its customers, following our information reputed company policies. This obligation continues even after employment ends, including secure handling of data and access management. Functional: • Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards. • Collaborates with UM team to resolve reputed company processing issues. • Maintains knowledge of regulations, accreditation standards, and industry best practices reputed company to Utilization Management. • Works with UM team and senior management to identify opportunities for process and quality improvements reputed company UM reputed company. • Educates and provides resources for the UM team on key initiatives and to facilitate on-going communication between UM team, members, and providers. • Monitors prior authorization, and/or retrospective clinical review team and ensures compliance with applicable guidelines, policies, and procedures. • Works with Senior Management to reputed company, monitor, and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services. • Evaluates UM team performance and provides feedback regarding performance, goals, and career milestones. • Coordinates staff scheduling based on workflow needs, and maintains tracking and logging of staff attendance, production metrics, and timecards. • Provides coaching and guidance to UM team to ensure adherence to quality and performance standards by utilizing metrics and management reports to monitor. • Assists with onboarding, hiring, and training UM team members. • Leads and champions change reputed company scope of responsibility. • Performs other duties as assigned. • Demonstrate knowledge and understanding of client reputed company and performance requirements, authorization processing workflow, approval/denial, and letter reputed company processes. • Manage inventory and reputed company recommendations for improving outcomes. • Provides ongoing communications with the staff to ensure their operational skills and capabilities are maintained. Core: • Shows a high level of dedication to a commitment to excellence, working hard to deliver on commitments to others and ensure quality of care. • Holds self and others accountable to meet commitments. • Makes good and timely decisions that reputed company the organization moving reputed company. • Executes a solution-oriented approach to conflict and challenges. Makes sense of reputed company and high quantity information to effectively solve problems. • Ability to convey information and engage an audience in a professional setting. • Work with other internal departments as necessary to implement strategies to proactively manage utilization volume reputed company each market to assure client turnaround times are met. • Provide recommendations on department policies, objectives, and initiatives. Evaluate and suggest changes as necessary to optimize processes and efficiencies. Works in partnership with reputed company personnel to improve system efficiency and collaborate on reputed company barriers that arise. • Ability to operate in a fast-paced environment under tight deadlines. • Ensures that the right systems, processes, and measurements are in reputed company to assist with accurate clinical determinations. Behavioral: • Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. • Initiative: readiness to reputed company or take action to reputed company goals. • Communicative: ability to reputed company issues, concepts, and reputed company to others easily orally and in writing. • Member-focused: going above and beyond to reputed company our members feel seen, valued, and appreciated. • Detail-oriented and thorough: managing and completing details of assignments without too much reputed company. • Flexible and reputed company: managing new demands, changes, and situations. • Critical Thinking: effectively troubleshoot reputed company issues, problem solve and multi-task. • reputed company & responsibility: acting with a clear sense of ownership for actions, decisions and to reputed company information confidential reputed company required. • Collaborative: ability to represent your own interests while being fair to those representing other or competing reputed company in search of a workable solution for reputed company parties. Minimum Qualifications: • High School Diploma or GED is required. • Dental Assistant certificate or 2 years of chair reputed company assisting • Experience in a leadership or management role required • Experience and knowledge in intermediate computer skills • Exhibit strong skills for reading, writing, and communicating at a professional level • Proficiency in managing multiple tasks and prioritizing work • Ability to think analytically and reputed company independent decisions • Ability to handle multiple and changing priorities • Capable of maintaining positive working relationships • Effective time management and organizational skills • Ability to work overtime as needed • Internet & Workspace: A reliable internet reputed company (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role. Preferred Qualifications: • Management/supervisory experience, 4 or more years. • 5 years clinical experience in the dental industry is a plus. • Knowledge of Medicare, Medicaid, and Commercial insurance. • Clinical experience reputed company the dental and/or optical field preferred. • HCPCS, CPT, CDT, ICD 10 coding experience preferred. • Requires research and analytic skills or an ability to reputed company, understand, and reputed company the results of the research and analysis to reputed company many of the responsibilities outlined above. • Knowledge and understanding of regulatory language. • Excellent oral and written communications skills. • Experience managing cross functional projects. • Knowledge of managed reputed company plans operations and HIPAA (Health Insurance Portability and Accountability) guidelines. • Strong skills using reputed company applications and other windows-based tools. FLSA Status: Salary/Exempt National Salary Range: $55,790 - $87,230 Annual Incentive Plan (AIP) reputed company - 2.5% How To Stay Safe: reputed company is aware of fraudulent activity by individuals falsely representing themselves as reputed company recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to reputed company purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company. reputed company would never reputed company such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social reputed company numbers, during our process. Our recruitment process takes reputed company by phone and reputed company trusted business communication platform (i.e., reputed company, Webex, reputed company Teams, etc.). Any emails from reputed company recruiters will come from a verified email address ending in @reputed company.com. We urge reputed company applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reputed company out to ITsupport@reputed company.com. To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam). If you reputed company you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. reputed company is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity. 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 reputed company and reputed company 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 reputed company for inclusion and diversity in reputed company that we do. • Social responsibility in reputed company aspects of our work. We volunteer reputed company our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability. Equal Employment Opportunity At reputed company, We See You. We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers reputed company qualified applicants and does not discriminate against any person based on reputed company, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national reputed company, race, religion, sexual orientation, or any other characteristic. At reputed company, we reputed company that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, reputed company focused on providing a world-class experience for our clients. We focus on recruiting, training and retaining those individuals that share similar goals. Come Dare to be Different at reputed company, where We See You! Apply Job!