Resp & Qualifications
Candidates must live in the DMV with the ability to travel into the offices a few days per week.
PURPOSE:
Responsible for clinical and provider network management for dental organization. Directs daily departmental activities that generally include care management, interpreting dental/medical policy, quality improvement, disease management, utilization review, and dental/medical claims review, network recruitment, credentialing, provider directory information and provider relations. Provides thought leadership for oral health to internal and external parties.
ESSENTIAL FUNCTIONS:
- Oversees network management and dental consultant teams. Develops strategies and programs to assure appropriate and cost-effective dental care for CareFirst Members. Ensures both efficient productivity and decision-making alignment of clinical reviews for dental, medical quality of services and clinical Special Investigation Unit (SIU) research. Updates dental and medical policies to reflect the current state of oral health care delivery. Leads provider network management team to secure network adequacy and respond to client and member needs.
- Serves as a subject matter expert/thought leader and team member for various departments that incorporate oral health and dental benefits, such as for Operations, Customer Experience, Product Development, Sales and Account Management, Continuing Education programs, Care Coordination, and Healthworx. Presents both internally and externally at meetings and events, representing Care First's oral health program and dental network. Participates actively as the CareFirst dental representative with industry-related organizations, attending and presenting at events and meetings to network and gather industry initiatives that support innovation activities at CareFirst that keep the organization current on standards of operations and care.
- Oversees dental plan claim administration by assuring correct implementation of contract provisions, benefit levels, applicable state and federal regulations, and community standards of care. Incumbent has the authority to override established benefit levels when necessary. Serve on the Dental Leadership Group and governance boards as appointed. Chairs the Dental Advisory and Oral Surgery Advisory Committees and also chairs the Dental Credentialing Committee. Engage with the dental provider community and organized dentistry associations.
- Recruits, retains and develops a high performing team. Sets goals and develops budget.
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Medical Degree in Dentistry.
Licenses/Certifications:
- DDS - Doctor of Dental Surgery Upon Hire Required or
- DDM - Doctor of Dental Medicine Upon Hire Required and
- Current license for the jurisdictions of Maryland and DC Required
Experience: 8 years experience in dental health care or medical management. 3 years management experience.
Preferred Qualifications:
- Board Certification. Completion of a general practice hospital-based residency or completion of a 2 year AEGD program.
- Dental insurance utilization management and/or provider relations experience.
Knowledge, Skills and Abilities (KSAs)
- Strong interpersonal skills. Ability to work independently, as well as a member of a team.
- Strong critical reasoning skills in clinical decision-making, planning and organizing.
- Current knowledge of clinical practices and related information systems and computer applications, required.
- Previous experience in a dental practice.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $203,760 - $378,230 (salaries are based on education, experience & internal equity)
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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