Job Title:

DBM I/DD Dental Director

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 dental care and benefits management for individuals with intellectual and developmental disabilities (I/DD) to ensure high-quality dental services are available and tailored to their unique needs under the Tennessee Medicaid dental insurance program.

Primary Job Responsibilities:

• Oversees the administration and management of dental benefits for Medicaid beneficiaries and leads the development and implementation of dental care programs specifically designed for individuals with I/DD to ensure high-quality services are available and tailored to their specific needs in compliance with all applicable standards and in support of the Delta Dental Utilization Management Program Plan.

• Develops and implements policies and procedures to ensure efficient and effective delivery of dental services.

• Monitors and evaluates the utilization of dental benefits to ensure compliance with Medicaid regulations, nationally recognized quality standards and company standards.

• Collaborates with the claims department to resolve issues related to dental benefit claims and reimbursement.

• Provides education and training to dental providers on Medicaid policies, clinical best practices, and care for individuals with I/DD.

• Develops and oversees quality assurance initiatives to improve the delivery of dental services including, but not limited to, over and under-utilization of available dental benefits.

• Conducts regular audits and reviews of clinical practices to ensure adherence to established standards and contractual guidelines.

• Develops and implements quality improvement programs to enhance patient outcomes and satisfaction.

• Prepares and submits required reports and documentation to regulatory agencies.

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

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

• 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 five years of experience in a clinical practice setting, with a focus on care for individuals with intellectual and developmental disabilities. Previous experience with I/DD Medicaid waiver populations in a Federally Qualified Health Center or private practice is 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.