Posted:
11/25/2024, 7:09:54 AM
Location(s):
Michigan, United States
Experience Level(s):
Senior
Field(s):
Operations & Logistics
Job Title:
Director, Government Programs Clinical OperationsNumber of Positions:
1Location:
Okemos, MILocation Specifics:
Hybrid PositionJob Summary:
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:
To plan, organize, and direct the daily activities of the Government Programs Clinical Operations department to ensure that goals and objectives are met.
Primary Job Responsibilities:
Directs and evaluates departmental activities to ensure continuous improvement of programs and services for provider records management, claims review, provider focused review and professional relations.
Directs, develops, evaluates and implements appeals/grievance processes, prior authorizations, and claims review processes including corporate and departmental policies and procedures.
Interviews, hires, evaluates and develops staff in order to ensure accountability for achievement of department goals and objectives.
Develops, recommends and oversees implementation of new programs.
Develops and implements short- and long-term strategy, goals and objectives.
Coordinates with Dental Director to develop criteria for utilization management decisions to support all customer and state contracts.
Develops, recommends and monitors the annual departmental budget.
Develops, recommends and enforces policies, procedures, guidelines and standards of operation.
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 or a related field, seven years of experience in the business of dentistry and five years of leadership experience. Will accept any suitable combination of education, training, or experience.
Position requires advanced knowledge of dental terminology and procedures, as well as dental profession and dental insurance products, effective verbal and written communication skills, advanced knowledge of management practices; ability to analyze and resolve complex problems, and use independent judgment.
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.
Website: https://www.deltadentalins.com/
Headquarter Location: San Francisco, California, United States
Employee Count: 1001-5000
Year Founded: 1955
Industries: Health Care ⋅ Health Insurance ⋅ Insurance