Position Purpose: Perform duties to conduct and manage the day to day operations of theutilization management function. Communicate with staff to facilitate daily department functions.
Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ years utilization management and recent experience in a clinical setting. Utilization management and dental records revision experiencerequired. Familiarity with Medicare and Medicaid managed care practices and policies, CHIP and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
License/Certification: Possess an active, professional and unrestricted license as a Licensed Dental Hygienist to practice as a health professional in a state or territory of the United States. The license has a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. Case Management Certification preferred.