|Job Title||Director Professional Services|
|Location||Rancho Cordova, CA, US|
|Organization Name||Professional Services - Dental Affairs|
The incumbent in this position is responsible for the quality of care programs and activities of the Enterprise. The incumbent oversees the Dental Consultants of the Quality Assessment, Quality Management and Subscriber Services department. The incumbent is also responsible for ensuring compliance with regulatory and contractual requirements for quality of care issues, providing support and advice regarding dental policy issues and serving as Chair of the Quality Assessment Committee.
Oversees quality of care programs and activities related to the assessment of quality and access to care through grievances and appeals, credentialing review, patient and office examinations and utilization review. Leads and manages the Dental Consultants and staff of the Quality Assessment, Quality Management and Subscriber Services departments, including development and training, performance management and work assignments and responsibilities; develops and manages department budget. Applies professional judgment and dental policy to develop, implement and monitor standards for acceptable quality of care for all service lines of business. Provides oversight for the resolution of enrollee and provider grievances related to the quality of care delivered by participating dentists and/or the plan. Provides analytics and support in identifying trends, educational needs and corrective actions related to the structure and delivery of care by participating dentists; evaluates coverage, necessity and appropriateness of dental treatment for patients covered by Delta programs. Collaborates with Legal, Corporate, and other professional staff to develop and implement strategies to ensure enterprise compliance with regulatory and contractual requirements for clinical quality. Acts as a liaison to outside entities such as California Association of Dental Plans, California Dental Association and Department of Managed Health Care (DMHC) involving quality of care programs and/or other issues relating to compliance with laws and regulations. Collaborates with professionals (dental consultants and other clinical resources) to determine and gain Enterprise acceptance of policies and procedures regarding clinical quality benchmarks, monitoring processes and metrics. Compiles and submits performance reports for the division as required by the Enterprise. Provides input to other divisions as needed to serve Enterprise goals. Performs miscellaneous duties as assigned.
Active and unencumbered California dental license BA/BS in public health, biology or related field A minimum of 10 years' experience in the managed dental care environment Experience and/or strong working knowledge of the regulations in California under the Department of Managed Healthcare (DMHC) A minimum of 3 years' experience in conducting compliance audits of dental offices and/or managed dental care organizations A minimum of 5 years' experience and proficiency in data analysis involving statistics, trend analysis, cost analysis, forecasting and budgeting A minimum of 3 years interpreting, developing and promoting dental policy Broad knowledge and experience in clinical, academic and research in the dental environment Knowledge of health care industry issues Knowledge of Delta Dental products, policies, claims, eligibility and underwriting guidelines Proficiency in using and interpreting analytics software, such as MS Excel and Access A minimum of 5 years of management experience, involving managing both dentists and non-clinical staff A minimum of 5 years experience in data warehousing/mining and provider profiling techniques; ability to assess, develop and implement systems to support claims and regulatory compliance and stand alone databases; broad experience in decision support systems Experience conducting research in the dental/clinical environment; success in publishing papers in scientific journals a plus Executive-level communication and presentation skills required Exceptional writing ability and proven experience in clearly presenting written information and findings to a wide variety of internal and external audiences; publishing research results a plus Ability to clearly present technical information verbally to a variety of audiences and settings Ability to effectively manage dental professionals and other staff in a manner commensurate with their level of education and professionalism Ability to influence staff performance positively by encouraging and rewarding exceptional performance and providing regular feedback Ability to identify staffing weaknesses; document performance issues and work with HR to rectify performance them General teamwork abilities, such as the ability to work collaboratively with staff, individuals from other departments across the Enterprise, direct supervisor, and superiors at all levels; and to accept direction and advice from them PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint); proficiency and design preferred Regularly required to work standard office equipment (personal computer, photocopy machine, fax machine, etc.) Ability to work on a computer up to 7 hours a day Ability to travel by car or by air, typically about 1 week per month but could be more; Expected to work onsite, in San Francisco, when not traveling on business Regularly required to sit for long periods of time, and occasionally stand and walk Regularly required to use hands to operate computer and other office equipment Close vision required for computer usage; occasionally required to stoop, kneel, climb and lift up to 25 pounds.
As an eligible candidate for a position at Delta Dental, you must possess the following:
- Ability to appear for work on time
- Ability to appear at a physical location
- Ability to perform job duties for a specific duration of time
- Ability to follow directions from a supervisor
- Ability to interact well with co-workers
- Ability to understand and follow work rules and procedures
- Ability to accept constructive criticism
- Ability to maintain regular/consistent attendance and adhere to scheduled shifts
- Ability to maintain regular/consistent attendance and a full-time schedule
- Ability to maintain current status on projects
- Ability to stay current on training/issues in field
|How To Apply|
|Click "Apply Now"|
|Amount of Travel|
|Work At Home|
|Eligible for Referral Bonus?|