Senior Director, Dental – Medicaid

This is a fully remote position, open to applicants in California.

📋 Description

• Act as the clinical authority overseeing Medicaid dental utilization management in designated markets.

• Create, evaluate, and uphold clinical policies, utilization management standards, and practice guidelines that conform to ADA standards, CMS regulations, and state laws.

• Lead, mentor, and provide support to State Dental Directors, Staff Dentists, and other clinical team members.

• Organize clinical calibration exercises and quality review processes.

• Engage in clinical governance committees and strategic initiatives within the organization.

• Supervise dental prior authorization, retrospective reviews, appeals, and utilization management programs.

• Analyze utilization patterns to identify opportunities for enhancing quality outcomes and healthcare affordability.

• Direct staffing, training, calibration, and performance expectations for utilization management clinicians and reviewers.

• Serve as a clinical subject matter expert during audits, regulatory reviews, readiness assessments, and corrective action plans.

• Collaborate with state agencies, regulatory bodies, and internal stakeholders to meet compliance standards.

• Monitor Medicaid regulations and spearhead operational enhancements.

• Offer expert clinical advice on complicated grievances, appeals, and escalated cases.

• Lead initiatives aimed at improving access, health outcomes, member experience, preventive care, and value-based care.

• Support care management programs and outreach strategies for high-risk members.

• Advocate for teledentistry and innovative care delivery models.

• Work alongside Quality Improvement teams on clinical performance and outcomes initiatives.

• Act as the clinical liaison to provider networks, dental associations, academic institutions, and key stakeholders.

• Assist providers in understanding utilization management criteria, coding requirements, benefit policies, and quality initiatives.

• Participate in Medicaid procurements, RFP responses, market implementations, and expansion opportunities.

• Collaborate with Clinical Performance, Analytics, and Actuarial teams to enhance affordability and quality.

• Help shape the clinical analytics roadmap and reporting strategies.

• Aid in the development of dashboards and reporting tools.

• Utilize managed care principles and data-driven insights to enhance clinical and financial outcomes.

• Lead, mentor, and develop high-performing teams.

• Cultivate stakeholder partnerships and influence cross-functional initiatives.

• Collaborate with leaders in Quality, Analytics, Provider Relations, Operations, Compliance, Claims, Network Management, Product, and Member Services.

• Represent Dental leadership in high-level executive discussions and organizational decision-making.

⛳️ Requirements

• DDS or DMD degree from an accredited dental school.

• Active, unrestricted dental license in at least one state in the U.S.

• Minimum of 12 years of clinical dental experience.

• Over 3 years of experience in utilization management, managed care, dental insurance, payer organizations, or Medicaid-focused healthcare settings.

• More than 3 years of experience in people leadership, technical leadership, or functional management.

• Proven track record in leading, coaching, and developing high-performing teams.

• Extensive knowledge of dental managed care, benefit structures, reimbursement methods, utilization management, and authorization workflows.

• Experience in creating clinical policies, managing utilization programs, and supporting regulatory compliance efforts.

• Strong understanding of Medicaid programs and government-funded healthcare environments.

• Exceptional leadership, communication, relationship-building, analytical, and strategic thinking abilities.

• Capability to influence executive stakeholders and lead complex organizational initiatives.

• Must be eligible to work in the United States.

• No sponsorship or relocation assistance available.

• Preferred: advanced degree in Public Health, Health Administration, Health Policy, Business Administration (MBA), or a related field.

• Preferred: experience managing multi-state Medicaid programs or national payer initiatives.

• Preferred: experience working 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.

🏝️ Benefits

• 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 the 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.