JOB DESCRIPTION

The Regional Dental Director - TX is responsible for ensuring professional Dental Health Maintenance Organization (DHMO) activities in assigned regional states are compliant with applicable state regulations and align with enterprise Quality Anchors. This role oversees quality improvement activities; develops quality improvement work plans; collects reporting to support audits and exams; serves on Quality Oversight Sub-Committees; and conducts clinical review of fraud, waste and abuse files. The Functional Dental Director serves as a subject matter expert and liaison during audits for all utilization management and quality program activities and helps to support Dental Quality Thought Leadership throughout the enterprise.

RESPONSIBILITIES

• Provides professional level decision-making and oversight for the credentialing, referral, grievance and appeals, claims, onsite audit, peer review, utilization management, medical necessity review, access and availability processes for assigned regional state DHMO programs to ensure compliance with state regulations.
• Monitors key areas of dental care delivery, identifies problems and opportunities to improve the quality of care to enrollees, and develops and oversees Quality Improvement Work Plans (QIWPs) and all data that supports QIWPs and Quality Oversight Committees.
• Serves on and prepares materials to support Quality Oversight Committees such as Credentialing, Utilization Management, Clinical Review Oversight, Peer Review, and Grievance Insights Committees; may serve as chairperson as required.
• Supports Dental Quality Thought Leadership including dental staff training and continuing education for the enterprise.
• Participates in quality assurance activities such as auditing or reviewing grievances and performing clinical review of claims, medical necessity denials, and potential quality issues.
• Works closely with the Network Oversight and Compliance Department on fraud, waste, abuse, and misrepresentation cases, providing clinical insights into investigations.
• Oversees and executes Dental Consultant Inter-Rater Reliability calibrations to ensure consistent clinical decisioning across the enterprise.
• Prepares for and participates in state, group, and regulatory exams and audits, representing the clinical oversight of all areas of quality.
• This list is not all-inclusive and you are expected to perform other duties as requested or assigned.

QUALIFICATIONS

• 7+ w/Bachelor's degree
• DDS or DMD degree required with a TX State Dental License in good standing and must have or be able to get a New Mexico and Nevada State Dental License.
• Must reside in the state of Texas.
• Strong time management and organizational skills
• Strong analytical and problem solving skills
• Catalyst for change
• Ability to navigate various technology platforms
• High level of accountability for delivery of audit and exam responses in a timely manner
• Excellent attention to detail
• Expert dental clinical knowledge
• Excellent verbal and written communication skills
• Expert knowledge of Microsoft Word, Power Point, Excel and virtual presentation skills (Zoom or Teams)

Base Pay Information

The national base pay range is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. $133,300 - $260,000

ADDITIONAL INFORMATION

Rewards to make you smile! We don't just want to make our customers happy - we want to give our employees a reason to smile, too. Delta Dental's comprehensive benefits package includes:

• Generous paid time off plus 12 holidays and your birthday off!
• Low-cost premium medical insurance options
• 100% paid dental and vision insurance
• Generous 401(k) matching and flat contribution
• Social responsibility and volunteer opportunities, including 16 paid volunteer hours annually
• Employee LiveWell program, focusing on overall employee well-being
• Fertility and diabetes benefits
• Employee discount program: AT&T/Verizon, entertainment, travel, and more!
• Culture of learning: career development and tuition reimbursement
• Career growth: we love promoting from within

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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ABOUT THE TEAM

At Delta Dental, our success is only as strong as the people who execute it! We take enormous pride in being the nation's most recognized and widely-used provider of dental insurance - and we've come this far by living our core values of innovation, excellence, service and trust. Our vision is to motivate and empower every employee so that we're all inspired to take exceptional care of our customers, providers and ourselves. We believe in integrity, accountability, collaboration, and giving every employee equitable opportunity for their voice to be heard and development to be fostered.

If you're excited about the prospect of transforming the future of health care and growing in your career, join our smile revolution!

To see some of the smiling faces behind Delta Dental and to learn more about what our values and culture look like in action, connect with us on social media: Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn.

We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation's largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.

Delta Dental is an equal opportunity employer. We are committed to building and maintaining a diverse and inclusive workplace for all employees. Applicants will not be discriminated against because of race, color, religion, creed, national origin, ancestry, citizenship status, sex (including pregnancy), sexual orientation, gender or identity expression, age, disability, marital status, medical status, veteran status or any other status protected under federal, state, or local law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico or other US Territories at this time.

Proof of eligibility to work in the United States must be provided if selected for hire.

Delta Dental* has enacted a COVID-19 vaccination policy to protect all employees and the communities we serve due to the ongoing impacts of the COVID-19 pandemic. Accordingly, we require all employees to be fully vaccinated for COVID-19. Are you able to comply with our policy of being fully vaccinated by your start date if an offer is made or have a medical or sincerely held religious exemption for receiving a COVID-19 vaccine? Failure to comply with our policy and submit proof of compliance or receive approval for a valid medical or sincerely held religious belief exemption prior to your start date will nullify any offer of employment extended to you.

• Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York