You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Location: We support US flexible working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: 
The Director, Vision is responsible for direct oversight and guidance of the clinical affairs and direction of the company’s Vision program. This includes, but is not limited to development of clinical guidelines, clinical algorithms, and chairmanship of all internal clinical committees for vision and eye care services, and clinical representation of company’s vision program at state and client level meetings. Additionally, the Clinical Vision Director is responsible for direct oversight of UR and clinical oversight of UM processes for the vision program. This position will assist the Vision, P&L Leader to provide program oversight, fiscal management, and technical expertise for the Vision strategic business unit.

How you will contribute: 

• Oversee Vision Utilization Management functions and processes.
• Oversee and manage Vision Utilization Review Functions, including Fraud Prevention and Recovery.
• Authorize or deny claims, prior-authorizations and appeals based on medical necessity and eligibility, in accordance to contract language and regulatory requirements.
• Maintain algorithms, guidelines and associated policies to ensure consistency with sound clinical criteria.
• Develop Quality Studies and UM initiatives.
• Chair Vision Credentialing and Peer Review Committees. 
• Represent Vision on appropriate enterprise committees.
• Interpret contract benefits and design benefit plans and establish fee schedules.
• Provide guidance on configuration and claims rules/edits.
• Represent company in state fair hearings.
• Manage clinical consultants.
• Provide clinical vision expertise to all departments and functions.
• Attend industry trade shows to develop and maintain relationships with state and health plan medical directors and industry experts. 
• Assist Vision Program leadership with expanding laboratory strategy consistent with membership growth and business opportunities.
• Organize provider focus groups or provider vision champion groups.
•  Coordinate and implement appropriate performance management strategies for team members to include: 
• Assist in the hiring process, including interviewing candidates.
• Assist, train and motivate team members.
• Evaluate and measure effectiveness of team members.
• Assist in preparation of performance and wage evaluations in accordance with company policy.
• Responsible for attendance and company approved time off for team members.
• Participate in the selection and implementation of Performance Improvement Plans and performance management initiatives.
•  Other duties as assigned. 

What you will bring with you:

• Doctor of Optometry (O.D.) or a Board-Certified Ophthalmologist (D.O. / M.D.).
• Maintain an active, current and unrestricted Optometric/Ophthalmologic/Medical license.
• 10 years of Clinical experience.
• Clinical familiarity with Vision insurance products.
• High level knowledge of Utilization Management and Utilization Review processes, procedures and functions.
• Interpersonal skills.
• Excellent written and verbal communication skills.
• Presentation and communication skills for client interactions or sales support.
• PC Skills – Word, Access, and Excel specifically.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions.
• Attends additional training as requested/deemed necessary
   

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you. 
  

Not ready to apply yet but want to stay in touch?  Join our talent community (https://pages.beamery.com/sunlifecareers/page/join-us-canada) to stay connected until the time is right for you! 

Life is brighter when you work at Sun Life 

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more 
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account  
• A flexible work environment with a friendly, caring, collaborative and inclusive culture  
• Great Place to Work® Certified in Canada and the U.S.  
• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running 

  

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. 

If you are a California resident, the salary range for this position is: 

• Southern California region: $147,000 - $220,500 annually
• Central California region: $155,000 - $232,500 annually
• Northern California region: $165,800 - $248.700 annually

If you are a Colorado or Nevada resident, the salary range for this position is $140,400 - $210,600 annually
If you are a Connecticut or Maryland resident, the salary range for this position is $147,000 - $220,500 annually
If you are Washington or Rhode Island resident, the salary range for this position is $155,000 - $232,500 annually
If you are a New York resident, the salary range for this position is $165,800 - $248.700 annually

We consider various factors in determining actual pay including your skills, qualifications, and experience.  In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits. 

 
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more. 

 
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs. 

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Project Management - Process

30/08/2024

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran