Job Title:

Associate 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:

Supports the oversight of 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:

• Supports the oversight of clinical operations 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.

• Participates in the development and implementation of quality assurance initiatives.

• Monitors and evaluates clinical performance metrics to ensure continuous improvement in service delivery.

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

• Provides clinical guidance and support to network dental providers to enhance patient care quality.

• Develops and facilitates provider education and training programs to promote adherence to clinical guidelines and Medicaid policies.

• Supports the development and implementation of innovative programs to enhance access to care and improve health outcomes.

• Stays informed about changes in Medicaid policies and update clinical practices accordingly to ensure compliance with all federal and state regulations and nationally recognized quality standards.

• Promotes patient-centered care and support initiatives that enhance patient education and engagement.

• Collaborates with community organizations and stakeholders through regular meetings and attendance at community events to promote benefit awareness, oral health education and preventive care.

• 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. 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 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.