Job Title:

DBM Chief Dental Officer

Number of Positions:

1

Location:

DDMI_Tennessee

Location Specifics:

Hybrid Position

Job Summary:

Must reside in Metropolitan Davidson County, Tennessee or a county contiguous to Metropolitan Davidson County, Tennessee.

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities for all. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description:

Oversees the clinical integrity, quality, and efficiency of dental services provided under the Tennessee Medicaid dental insurance program and ensures all dental care delivered meets the highest standards of quality and complies with federal and state regulations.

Primary Job Responsibilities:

• Provides clinical direction and oversight to ensure the delivery of high-quality dental care in compliance with all applicable standards and in support of the Delta Dental Utilization Management Program Plan.

• Develops, implements, and monitors clinical policies and procedures to maintain compliance with Medicaid regulations and nationally recognized quality standards.

• Oversees the credentialing process for dental providers to ensure adherence to NCQA and company standards as well as any other applicable State of Tennessee regulatory requirements.

• Leads quality assurance initiatives to improve patient outcomes and service delivery.

• Implements and directs clinical quality improvement programs, including performance metrics and benchmarks, including, but not limited to, over and under-utilization of available dental benefits.

• Conducts regular audits and reviews of clinical services to ensure quality and compliance with contractual guidelines and requirements.

• Serves as the primary liaison between the organization and network dental providers.

• Provides education, training, and support to dental providers on clinical best practices and Medicaid policies.

• Addresses and resolves provider issues and concerns related to clinical care.

• Collaborates with executive leadership to develop and implement strategic plans for dental services, utilization management, population health and quality assurance activities.

• Identifies and implements innovative programs to enhance access to care and improve health outcomes.

• Monitors industry trends, nationally recognized compliance standards, and regulatory changes to ensure the organization remains compliant and competitive.

• Ensures the implementation of patient-centered care models that improve access and satisfaction.

• Collaborates with community organizations and like-minded stakeholders to promote oral health education and preventive care.

• Interviews, hires, develops, and evaluates staff in order to ensure accountability for the achievement of corporate goals and objectives.

• Oversees a team of subject matter experts, including associate and/or specialty Dental Directors, as well as appropriate independent professional peer reviewers.

• Attends State and community stakeholder meetings and events, serving as a subject matter expert on Medicaid dental policy and benefits.

• Reviews and adjudicates prior authorizations and retrospective claims submitted by providers in accordance with company utilization management standards, clinical policies, and Medicaid guidelines.

#LI-Hybrid

Minimum Requirements:

Position requires a D.D.S. or D.M.D. from an accredited school of dentistry, an unrestricted license to practice dentistry in Tennessee, and seven years of experience in a clinical practice setting. Additional education in public health, public policy, or business administration is preferred. Previous experience in a public health setting or clinical experience delivering care to Medicaid populations in a Federally Qualified Health Center or private practice and/or previous experience within the dental insurance industry or state administration experience is also preferred. Will accept any suitable combination of education, training, or experience.

Position requires expert knowledge of dental terminology, dental procedures, and appropriate dental care; advanced knowledge of oral health education programs, utilization management, dental benefit administration, data collection, data analysis methodology and performance improvement methods needed to lead and support oral health quality assurance/performance improvement activities; strong verbal and written communication skills; strong interpersonal skills; strong analytical skills; the ability to identify and partner with key policy makers and stakeholders; the ability to lead and motivate others; and the ability to analyze and resolve highly complex problems using independent judgment.

Position requires travel of 10-25% throughout the state of Tennessee, and nationally as necessary.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.