DBM I/DD Dental Director

About the position At Delta Dental of Michigan, Ohio, and Indiana, we are dedicated to improving oral health through benefit plans, advocacy, and community support. As one of the largest dental plan administrators in the country, we are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. Our mission is amplified by investing in initiatives that build healthy, smart, vibrant communities for all. We celebrate our All In culture, which embodies a mindset and attitude that encourages taking charge of our careers, helping colleagues, and lending a hand in the community. The Dental Director for Individuals with Intellectual and Developmental Disabilities (I/DD) will oversee the dental care and benefits management for individuals with I/DD, ensuring that high-quality dental services are available and tailored to their unique needs under the Tennessee Medicaid dental insurance program. This role involves the administration and management of dental benefits for Medicaid beneficiaries, leading the development and implementation of dental care programs specifically designed for individuals with I/DD. The Director will ensure compliance with all applicable standards and support the Delta Dental Utilization Management Program Plan. In this position, the Director will develop and implement policies and procedures to ensure efficient and effective delivery of dental services. They will monitor and evaluate the utilization of dental benefits to ensure compliance with Medicaid regulations and nationally recognized quality standards. Collaboration with the claims department to resolve issues related to dental benefit claims and reimbursement is also a key responsibility. The Director will provide education and training to dental providers on Medicaid policies, clinical best practices, and care for individuals with I/DD, while also developing and overseeing quality assurance initiatives to improve the delivery of dental services. Regular audits and reviews of clinical practices will be conducted to ensure adherence to established standards and contractual guidelines, and quality improvement programs will be developed to enhance patient outcomes and satisfaction. Additionally, the Director will prepare and submit required reports and documentation to regulatory agencies and collaborate with community organizations to promote oral health education and preventive care. Responsibilities • Oversees the administration and management of dental benefits for Medicaid beneficiaries. , • Leads the development and implementation of dental care programs for individuals with I/DD. , • Develops and implements policies and procedures for efficient delivery of dental services. , • Monitors and evaluates the utilization of dental benefits for compliance with regulations and standards. , • Collaborates with the claims department to resolve dental benefit claims issues. , • Provides education and training to dental providers on Medicaid policies and best practices. , • Develops and oversees quality assurance initiatives to improve dental service delivery. , • Conducts regular audits and reviews of clinical practices for adherence to standards. , • Develops and implements quality improvement programs to enhance patient outcomes. , • Prepares and submits required reports and documentation to regulatory agencies. , • Collaborates with community organizations to promote oral health education and preventive care. , • Oversees the credentialing process for I/DD dental providers. , • Reviews and adjudicates prior authorizations and retrospective claims. Requirements • D.D.S. or D.M.D. from an accredited school of dentistry. , • Unrestricted license to practice dentistry in Tennessee. , • Five years of experience in a clinical practice setting, focusing on care for individuals with I/DD. , • Expert knowledge of dental terminology and procedures. , • Advanced knowledge of oral health education programs and utilization management. , • Strong verbal and written communication skills. , • Strong interpersonal and analytical skills. , • Ability to identify and partner with key policy makers and stakeholders. , • Ability to lead and motivate others. , • Ability to analyze and resolve complex problems using independent judgment. Nice-to-haves • Previous experience with I/DD Medicaid waiver populations in a Federally Qualified Health Center or private practice.

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