Job Title:

Dental Care Coordinator- Medicaid I/DD

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 delivery of dental care and benefits management for individuals with intellectual and developmental disabilities (I/DD) and coordinates with managed care organizations (MCO) to ensure the effective delivery of dental services.

Primary Responsibilities

• Coordinates with MCOs to ensure alignment on I/DD dental benefit offerings, network adequacy, and quality standards, including exchanging data such as member eligibility, referrals, treatment plans, stratification of proposed treatment plans procedures, authorizations, and other information, as necessary.

• Assists in monitoring utilization and effectiveness of dental benefits, making adjustments as needed to optimize care and access for I/DD population.

• Facilitates communication and collaboration between MCOs and I/DD dental providers to enhance service delivery.

• Designs, analyzes, tests and implements reporting and establishes controls to ensure data is reported accurately and consistently to MCOs and the state for I/DD members.

• Conducts regular reviews and audits to ensure compliance with Medicaid regulations and internal policies for I/DD population.

• Supports the identification and implementation of quality improvement initiatives to enhance patient outcomes and provider performance.

• Supports other quality initiatives for Medicaid population, including care coordination and case management, member outreach, attendance at community events, performance improvement projects, and value-based payment projects.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor’s degree in business administration, healthcare administration, public health or a related field and three years of experience utilizing analytical tools and software, dental claims billing or review, or dental software. Previous experience as a dental hygienist, or within a dental office treating I/DD patients is preferred. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of dental terminology and dental procedures; experience working with word processing, and spreadsheet software; strong verbal and written communication skills; strong organizational and analytical skills; ability to manage multiple assignments with competing deadlines; and the ability to resolve 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.