Pay Growth
?
out of 5
Not enough data
Not enough info to score pay or growth
Dental Director, Health Plan - REMOTE
Job
at Molina Healthcare in Idaho Falls, Idaho, United States
Remote
Full-Time
Review key factors to help you decide if the role fits your goals.
Job Security
?
out of 5
Not enough data
Calculating job security score...
Total Score
85
out of 100
Average of individual scores
Skill Insights
Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
at Molina Healthcare in Idaho Falls, Idaho, United States Job Description
JOB DESCRIPTION
Provides support and subject matter expertise for member clinical dental review activities. Responsible for determining appropriateness and medical necessity of member dental care services- targeting opportunities for quality improvement and satisfaction for members and providers. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties
- Oversees all aspects of utilization review and quality management activities related to dental care services for members, including appropriateness and medical necessity of dental care services provided.
- Provides oversight for dental quality programs including Healthcare Effectiveness Data and Information Set ( HEDIS ) and Pay For Performance (P4P).
- Develops and implements clinical utilization processes and algorithms utilized in the authorization process including: statistical methodology for use in utilization management, provider profiling analytics, dental policies and procedures and quality improvement activities.
- Partners with provider contracts to secure and maintain a network of dental providers.
- Meets or exceeds established review productivity standards.
- Educates and interacts with network and group providers regarding utilization practices, guideline usage, and effective member management; provides clinical representation for business presentations in partnership with provider relations.
- Provides guidance to staff regarding appeals, grievances and member/provider complaints.
- Provides analytics and interpretation of dental benefit plan structures.
- Maintains accountability for consumer/member related decisions for self and network of dental consultants.
- Ensures that the dental care provided meets the standards for acceptable dental care and that dental protocols and rules of conduct for plan personnel are followed.
- Participates in professional and community activities to provide input/demonstrate dental knowledge related to regulatory, professional and community standards, and issues. Required Qualifications
- At least 7 years of dental practice experience, including 3 years of experience working in a managed care, insurance, or benefits administration setting, or equivalent combination of relevant education and experience.
- Doctor of Medicine in Dentistry ( DMD ) or Doctor of Dental Surgery ( DDS ).