Inmediata Health Group is seeking a Dental Utilization Management Program Coordinator for our NetClaim Solutions line of business. Responsible for overseeing and managing the dental utilization management program. This role entails ensuring the effective implementation and monitoring of multiple activities to execute the business strategy under the dental business, adhere to regulatory standards, and manage costs initiatives effectively.

Requirements

Dental Assistant degree with expanded functions or equivalent degree.
Active Dental Assistant license in Puerto Rico
Two years of experience in dental utilization management, dental rules configuration and design highly preferred
Bilingual fluency in English and Spanish highly preferred.
Proficient in the Microsoft Office (Excel, PowerPoint, Word) and Adobe PDF.

Responsibilities

Establish and maintain policies and guidelines that align with regulatory requirements and best practices in dental care.
Ensure adherence to regulatory standards, including state and federal regulations, accreditation requirements, and organizational policies.
Lead the initial analysis, development, implementation, and continuous improvement of the dental utilization management program.
Support the development and maintenance of evidence-based clinical guidelines in collaboration with subject matter experts
Utilize data analytics to monitor utilization trends, identify areas for improvement, and implement corrective actions as needed
Serve as the primary point of contact for internal and external stakeholders regarding dental utilization management issues
Prepare and present reports on program performance, including key metrics, trends, and outcomes, to senior management and other stakeholders
Develop and deliver training programs for staff and providers on utilization management practices and policies/clinical guidelines

Equal Opportunity Employer Minorities/Females/Vets/Disability

Job Type: Full-time

Benefits:

401(k)
Health insurance

Work Location: In person

Inmediata Health Group

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