Dental Director, Health Plan - REMOTE

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, contributing to an overarching strategy to provide quality and cost‑effective member care.

• Oversee all aspects of utilization review and quality management activities related to dental care services for members, including appropriateness and medical necessity.
• Provide oversight for dental quality programs including HEDIS and Pay For Performance (P4P).
• Develop and implement clinical utilization processes and algorithms used in the authorization process, including statistical methodology, provider profiling analytics, dental policies and procedures, and quality improvement activities.
• Partner with provider contracts to secure and maintain a network of dental providers.
• Meet or exceed established review productivity standards.
• Educate and interact with network and group providers regarding utilization practices, guideline usage, and effective member management; provide clinical representation for business presentations in partnership with provider relations.
• Provide guidance to staff regarding appeals, grievances, and member/provider complaints.
• Provide analytics and interpretation of dental benefit plan structures.
• Maintain accountability for consumer/member related decisions for self and network of dental consultants.
• Ensure that the dental care provided meets the standards for acceptable dental care and that protocols and rules of conduct for plan personnel are followed.
• Participate in professional and community activities to demonstrate dental knowledge related to regulatory, professional, and community standards and issues.

• 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) with an active, unrestricted license in the state of practice.
• Health care management/leadership experience preferred.
• Current clinical knowledge.
• Ability to gather information and coordinate workflows.
• Ability to work independently and within a team environment.
• Effective time‑management and organizational skills.
• Critical thinking and listening skills.
• Decision‑making and problem‑solving skills.
• Excellent verbal and written communication skills.
• Proficiency with Microsoft Office suite and applicable software programs.

• Experience in peer review, medical policy/procedure development, and provider contracting.
• Knowledge of NCQA, HEDIS, Medicare, IPA, capitation, HMO regulations, managed health care systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence‑based guidelines.
• Active dental licensure in Southwest region (AZ, CA, NV, NM, TX).
• Active membership in a recognized professional organization, such as the American Dental Association (ADA) or National Dental Association (NDA).

Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $129,504 - $215,040 / ANNUAL