Dental Director, Health Plan - REMOTE

<div><strong>Job Description</strong><br/><br/><strong>JOB DESCRIPTION</strong><br/><br/>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.<br/><br/><strong>Essential Job Duties</strong><br/>• 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.<br/> • Provides oversight for dental quality programs including Healthcare Effectiveness Data and Information Set (HEDIS) and Pay For Performance (P4P).<br/> • 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.<br/> • Partners with provider contracts to secure and maintain a network of dental providers.<br/> • Meets or exceeds established review productivity standards.<br/> • 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.<br/> • Provides guidance to staff regarding appeals, grievances and member/provider complaints.<br/> • Provides analytics and interpretation of dental benefit plan structures.<br/> • Maintains accountability for consumer/member related decisions for self and network of dental consultants.<br/> • 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.<br/> • Participates in professional and community activities to provide input/demonstrate dental knowledge related to regulatory, professional and community standards, and issues. <br/><br/><strong>Required Qualifications</strong><br/>• 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.<br/> • Doctor of Medicine in Dentistry (DMD) or Doctor of Dental Surgery (DDS). License must be active and unrestricted in state of practice.<br/> • Health care management/leadership experience preferred.<br/> • Current clinical knowledge.<br/> • Ability to gather information and coordinate workflows.<br/> • Ability to work independently and within a team environment.<br/> • Effective time-management and organizational skills.<br/> • Critical thinking and listening skills.<br/> • Decision-making and problem-solving skills.<br/> • Excellent verbal and written communication skills.<br/> • Microsoft Office suite/applicable software program(s) proficiency.<br/><br/><strong>Preferred Qualifications</strong><br/>• Peer review, medical policy/procedure development and provider contracting experience. <br/> • 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.<br/><ul> <li>Active dental licensure in Southwest region (AZ, CA, NV, NM, TX).</li> <li>Active membership in a recognized professional organization, such as the American Dental Association (ADA) or National Dental Association (NDA).</li></ul><br/>To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.<br/><br/> Molina Healthcare offers a competitive benefits and compensation package.</div>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

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6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...