Senior Director, Dental – Medicaid

🕒 4 dias atrás

🏄 California – Remoto

🏄 California – Remote

💵 $168.500 - $218.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Diretor

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Liberty Dental Plan

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 2002

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

A Liberty Dental Plan é uma fornecedora de seguros dentais com sede nos EUA, oferecendo planos dentais para Medicaid (incluindo Medi-Cal), Medicare Advantage, comercial, individual & familiar e para grupos em diversos estados. A empresa opera serviços voltados para membros (localizador de dentistas, portal do membro, aplicativo móvel, ferramentas de elegibilidade e de sinistros) e serviços voltados para prestadores (portal do provedor, inscrição na rede, envio de sinistros, diretrizes clínicas e programas baseados em valor). A Liberty Dental Plan foca na administração de benefícios dentais, gestão de rede de prestadores, conformidade e credenciamento, e atende membros, prestadores e corretores.

Descrição

• Serve as the clinical authority for Medicaid dental utilization management across assigned markets • Develop, review, and maintain clinical policies, utilization management criteria, and practice guidelines aligned with ADA standards, CMS requirements, and state regulations • Lead, mentor, and support State Dental Directors, Staff Dentists, and clinical team members • Facilitate clinical calibration exercises and quality review activities • Participate in clinical governance committees and strategic organizational initiatives • Oversee dental prior authorization, retrospective review, appeals, and utilization management programs • Analyze utilization trends and identify opportunities to improve quality outcomes and healthcare affordability • Guide staffing, training, calibration, and performance expectations for utilization management clinicians and reviewers • Serve as clinical subject matter expert during audits, regulatory reviews, readiness assessments, and corrective action initiatives • Partner with state agencies, regulators, and internal stakeholders on compliance requirements • Monitor Medicaid regulations and drive operational improvements • Provide expert clinical guidance on complex grievances, appeals, and escalated cases • Lead initiatives improving access, health outcomes, member experience, preventive care, and value-based care • Support care management programs and high-risk member outreach strategies • Promote teledentistry and emerging care delivery models • Collaborate with Quality Improvement teams on clinical performance and outcomes programs • Serve as clinical liaison to provider networks, dental associations, academic partners, and key stakeholders • Support provider education on utilization management criteria, coding requirements, benefit policies, and quality initiatives • Participate in Medicaid procurements, RFP responses, market implementations, and expansion opportunities • Partner with Clinical Performance, Analytics, and Actuarial teams to improve affordability and quality • Help shape the clinical analytics roadmap and reporting strategy • Support development of dashboards and reporting tools • Leverage managed care principles and data-driven insights to improve clinical and financial outcomes • Lead, coach, and develop high-performing teams • Build stakeholder partnerships and influence cross-functional initiatives • Partner with Quality, Analytics, Provider Relations, Operations, Compliance, Claims, Network Management, Product, and Member Services leaders • Represent Dental leadership in executive-level discussions and organizational decision-making

🎯 Requisitos

• DDS or DMD degree from an accredited dental school • Active, unrestricted dental license in at least one U.S. state • Minimum of 12 years of clinical dental experience • 3+ years of experience in utilization management, managed care, dental insurance, payer organizations, or Medicaid-focused healthcare environments • 3+ years of people leadership, technical leadership, or functional management experience • Proven success leading, coaching, and developing high-performing teams • Deep knowledge of dental managed care, benefit structures, reimbursement methodologies, utilization management, and authorization workflows • Experience developing clinical policies, managing utilization programs, and supporting regulatory compliance initiatives • Strong understanding of Medicaid programs and government-funded healthcare environments • Exceptional leadership, communication, relationship-building, analytical, and strategic thinking skills • Ability to influence executive stakeholders and lead complex organizational initiatives • Must be able to work within the United States • No sponsorship or relocation assistance available • Preferred: advanced degree in Public Health, Health Administration, Health Policy, Business Administration (MBA), or related field • Preferred: experience leading multi-state Medicaid programs or national payer initiatives • Preferred: experience collaborating with state Medicaid agencies and participating in regulatory audits • Preferred: knowledge of value-based care models, provider performance management, and quality improvement strategies • Preferred: familiarity with teledentistry and digital health solutions

🏖️ Benefícios

• Competitive pay structure and savings options • Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines • Affordable medical insurance with low-cost premiums for employee-only coverage; Liberty subsidizes eligible dependent coverage • 100% employer-paid dental coverage for employees and eligible dependents • Vision insurance with low-cost premiums for employee-only coverage and dependents • Company-paid basic life and AD&D insurance equal to one times base salary, with options to purchase supplemental coverage • Flexible Spending Accounts for healthcare and dependent care expenses • Voluntary accident, critical illness, and hospital indemnity insurance • Long-term disability coverage • Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts • Employee Assistance Program (EAP) for mental health and well-being • Generous vacation and sick leave policies, with ability to roll over unused time • 10 paid company holidays • Tuition reimbursement for eligible educational expenses • Remote or hybrid work options available for various positions • Potential bonuses