Molina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molin
Dental Director, Health Plan
Location
Arizona
Posted
1 day ago
Salary
$129.5K - $215.0K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Dental Director, Health Plan
Molina Healthcare
Dental Director, Health Plan - REMOTE Location: AZ, United States; Arizona; Phoenix, Arizona; Provo, Utah; Mesa, Arizona; Utah; Chandler, Arizona; Scottsdale, Arizona; Nevada; Tucson, Arizona Remote Full-time JOB DESCRIPTION Provides support and subject matter expertise for member clinical dental review activities. Responsible for determining appropriateness and medical necessity of member dental care services - targeting opportunities for quality improvement and satisfaction for members and providers. Participates with senior leadership to establish strategic plans and objectives. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Oversees all aspects of utilization review and quality management activities related to dental care services for members, including appropriateness and medical necessity of dental care services provided. • Provides oversight for dental quality programs including Healthcare Effectiveness Data and Information Set (HEDIS) and Pay For Performance (P4P). • Develops and implements clinical utilization processes and algorithms utilized in the authorization process including: statistical methodology for use in utilization management, provider profiling analytics, dental policies and procedures and quality improvement activities. • Partners with provider contracts to secure and maintain a network of dental providers. • Meets or exceeds established review productivity standards. • Educates and interacts with network and group providers regarding utilization practices, guideline usage, and effective member management; provides clinical representation for business presentations in partnership with provider relations. • Provides guidance to staff regarding appeals, grievances and member/provider complaints. • Provides analytics and interpretation of dental benefit plan structures. • Maintains accountability for consumer/member related decisions for self and network of dental consultants. • Ensures that the dental care provided meets the standards for acceptable dental care and that dental protocols and rules of conduct for plan personnel are followed. • Participates in professional and community activities to provide input/demonstrate dental knowledge related to regulatory, professional and community standards, and issues. Required Qualifications • At least 7 years of dental practice experience, including 3 years of experience working in a managed care, insurance, or benefits administration setting, or equivalent combination of relevant education and experience. • Doctor of Medicine in Dentistry (DMD) or Doctor of Dental Surgery (DDS). License must be active and unrestricted in state of practice. • Health care management/leadership experience preferred. • Current clinical knowledge. • Ability to gather information and coordinate workflows. • Ability to work independently and within a team environment. • Effective time-management and organizational skills. • Critical thinking and listening skills. • Decision-making and problem-solving skills. • Excellent verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Peer review, medical policy/procedure development and provider contracting experience. • Knowledge of National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), Medicare, Group/Independent Physician Association (IPA), capitation, health management organization (HMO) regulations, managed health care systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management and evidence-based guidelines. - Active dental licensure in Southwest region (AZ, CA, NV, NM, TX). - Active membership in a recognized professional organization, such as the American Dental Association (ADA) or National Dental Association (NDA). Pay Range: $129,504 - $215,040 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package.
Related Guides
Related Categories
Related Job Pages
More Director Jobs
• lead teams of nurses and behavior health professionals responsible for care management • oversee the assessment and evaluation of members' needs and requirements to achieve and/or maintain an optimal wellness state • guide the development, implementation, and evaluation of care management programs to align organizational objectives and regulatory requirements • monitor data sharing among internal and external resources to ensure service integration, continuity of care, challenges, risk, and opportunities • facilitate effective communication and collaboration with internal and external stakeholders, including providers, payers, and regulatory agencies • lead the preparation and presentation of program reports, utilizing data analytics to monitor performance, identify trends, and recommend improvements • champion initiatives for process improvement and innovation to advance care management practices and outcomes
Program Director
Molina HealthcareMolina Healthcare is a Fortune 500 managed care company with a storied history that dates back to 1980 and the opening of a medical clinic by Dr. C. David Molin
Program Director - Remote CA Location: Long Beach, CA, United States Remote JOB DESCRIPTION Job Summary Responsible for the Management of internal business projects and programs involving department or cross-functional teams of subject matter experts, delivering products through the design process to completion. Plans and directs schedules as well as project budgets. Monitors the project from inception through delivery. May engage and oversee the work of external vendors. Assigns, directs, and monitors system analysis and program staff. These positions’ primary focus is project/program management, rather than the application of expertise in a specialized functional field of knowledge although they may have technical team members. Senior Program Management professional. Responsible for overall governance across all operational and strategic portfolio of projects; strong management and leadership skills; should be well experienced and comfortable presenting to C level executives; ability to drive structure and organization; extensive working knowledge of portfolio and project management tools and methodologies; ability to quickly assimilate information and make informed decisions; logical, analytical thinker with great influencing, written and verbal communication abilities; ability to handle multiple priorities and deal with ambiguity; provide oversight over the strategic and operational portfolios; manage strategic relationship with Corporate EPMO and IT. Manage the issue escalation/resolution process. KNOWLEDGE/SKILLS/ABILITIES - Manages programs using staff and matrixed resources with oversight from AVP and VP as needed - Serves as industry Subject Matter Expert in the functional area and leads programs to meet critical needs - Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management - Consultative role, develops business case methodologies for programs, develops and coordinates implementation of business strategy - Collaborates and facilitates activities with other units at corporate and Molina Plans. JOB QUALIFICATIONS Required Education Bachelor's degree or equivalent combination of education and experience Required Experience 7-9 years Preferred Education Graduate Degree or equivalent combination of education and experience Preferred Experience 10+ years Preferred License, Certification, Association CPHQ Pay Range: $92,474 - $180,324 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Job Type Full Time
• Lead pricing strategy for federal proposals, task orders, and contract modifications. • Review RFPs, RFQs, and IFBs to identify pricing requirements and risks. • Develop and oversee complex cost models and compliant cost proposals. • Coordinate pricing input with Business Development, Operations, Finance, and subcontractors. • Conduct profitability, sensitivity, and pricing-risk analyses. • Lead internal pricing reviews and present recommendations to executive leadership. • Ensure compliance with FAR, DFARS, CAS, and Truthful Cost or Pricing Data requirements. • Support government inquiries, audits, negotiations, and final proposal revisions. • Maintain pricing tools, templates, databases, and internal processes.
• Own the corporate-level relationships and sector-head relationships at Compass, Sodexo, Aramark, and Canteen • Drive Joint Business Plans (JBPs) with each of the four enterprise customers • Design and execute Sales Performance Incentive Fund (SPIFF) programs and distributor incentive programs • Manage Group Purchasing Organization (GPO) and distributor Joint Business Plan touchpoints • Coordinate College & University (C&U) pull-through with the Sr. Director, Foodservice and Regional Foodservice Managers • Drive new unit placements across the four concessionaires • Drive product placement, account programming, and Limited-Time Offer (LTO) execution • Build and manage per-serving cost models, distributor Joint Business Plans (JBPs), and chain-economics frameworks • Partner with distributor Operating Company (OPCO) leadership to drive pull-through • Maintain Customer Relationship Management (CRM) records daily after every meaningful customer interaction • Deliver consistent pipeline updates and forecasts to the Sr. Director, Foodservice • Contribute to Quarterly Business Review (QBR) and annual planning cycles



