Senior Director Clinical Quality and Policy

Job Description

The Senior Director of Clinical Quality & Policy provides enterprise clinical leadership for a transforming dental health plan, ensuring that clinical policy, quality strategy, and utilization management are grounded in evidence‑based care, data‑driven decision‑making, and whole‑person health outcomes. This leader will be accountable for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, while also helping shape the organization’s broader clinical positioning in the marketplace and supporting the development of integrated care models that connect oral health to whole person health.

The Senior Director brings strong clinical credibility, policy expertise, business acumen, and strategic leadership to help influence enterprise priorities, provider engagement, quality outcomes, and market differentiation. This role operates as a peer executive leader and consensus builder across clinical, operational, and enterprise stakeholders.

• Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
• Influence provider strategy by translating clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches.
• Help shape the organization’s clinical positioning in the marketplace through thought leadership, external credibility, provider engagement, and strategic partnerships.
• Ensure policies orient the company and providers toward delivery of patient health through policy design, execution, and compliance; develop and govern dental clinical protocols, standards of care, and evidence‑based guidelines; advise on best practices, emerging science, and oral‑systemic health principles; chair or co‑chair clinical policy governance forums; translate clinical policy into actionable intent for utilization management and quality programs.
• Enable continuous Clinical Quality Improvement by providing leadership focused on outcomes, effectiveness, variation reduction, and continuous improvement; oversee clinical quality programs that monitor member outcomes, safety, and care appropriateness; use data and analytics to identify improvement opportunities; bring stakeholders together around shared clinical and quality objectives.
• Drive strategy, innovation, and transformation by aligning dental clinical strategy with broader business goals, including growth, innovation, and integrated care; contribute to initiatives focused on medical‑dental integration, oral‑systemic health, and whole‑person care.
• Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight; serve as a trusted clinical voice for internal stakeholders and external partners; represent Delta Dental of California and affiliated companies when working with industry representatives.

Minimum Qualifications

• 12+ years of experience with a Bachelor’s degree; 3+ years of management experience.

Additional Experience

• DDS or DMD required.
• Active, unrestricted dental license, or ability to obtain appropriate licensure if required.
• Minimum of 10 years of transformational leadership experience in dental, managed care, health plan, payer, or related healthcare environments.
• Significant experience in clinical quality, utilization management, clinical review, and clinical policy.
• Demonstrated experience in both direct clinical care and administrative leadership.
• Experience applying evidence‑based practice, clinical research, or scientific literature to clinical policy, quality, or care model decisions.
• Proven ability to influence senior leaders and work effectively across a complex, matrixed organization.
• Strong strategic thinking and ability to translate clinical expertise into business and operational impact.
• Senior‑level leadership experience in clinical quality, clinical policy, utilization management, or related roles within a health plan, healthcare organization, or integrated care environment.
• Strong executive presence with the ability to influence, build consensus, and lead through change.

Knowledge, Skills, Abilities

• Advanced…