Utilization Management Supervisor
DentaQuest - Mequon, WI

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JOB SUMMARY: The Clinical Review Supervisor is responsible for the direct oversight of the Lead Examiners, Benefit Examiners, Orthodontic staff, and UM Administrative staff. The Clinical Review Supervisor is responsible for assisting the Manager with guiding and motivating team members, completing special projects and performance management of staff. The Clinical Review Supervisor is responsible for monitoring turnaround times and ensuring that client contract requirements are met on a consistent basis. In addition, this individual is responsible for continuously evaluating the department policies and procedures and developing and implementing process improvements to enhance the functionality and cost-effectiveness of the department.

Ensure department is meeting client expectations and terms of contract requirements.

Monitor daily and monthly turnaround time to ensure compliance with client contract requirements, and recommend necessary policies and procedures to UM Manager to ensure compliance.

Serve as liaison for issues between departments, DentaQuest, and DentaQuest clients.

Oversee and serve as a resource for the Benefit Examiners in the review and pre-authorization of major dental services based on medical necessity and eligibility, in accordance to contract language.

Read and interpret x-rays, models, photos, patient charts.

Review daily market reports and update determinations.

Communicate claim review outcome to participating Dentists, plan members, and Health Plans.

Facilitate resolutions to internal and external issues.

Identify efficiencies and improve workflow and efficiencies in department.

Assist in responding to and resolving complaints and requests from provider offices.

Update UM Manager on complaints and issues from clients and internal staff.

Assist in the ongoing evaluation of policies and procedures.

Assist in the hiring process, including interviewing candidates.

Prepare performance and wage evaluations in accordance to company policy.

Ensure organization of quality audits by clients.

Responsible for coordinating and implementing appropriate strategies for motivating team members.

Assist in conducting monthly staff meetings.

Responsible for attendance and company approved time off for department team members.

Required Skills

Required Experience

5+ years of dental assisting experience or degree in dental field.

Experience in a leadership capacity required.

Knowledge of general computer software.

Ability to read and interpret x-rays, dental models, photos, and/or patient charts.

Excellent interpersonal skills.

Excellent written and verbal communication skills.

Good PC Skills.

Ability to prioritize and organize multiple tasks.

Ability to remain organized with multiple interruptions.

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