Clinical Director, Dental

Our client exists to make positive contributions to our customers' good health and well being by providing affordable benefit solutions tailored to meet their needs.  They serve their customers best and create unique value by building and maintaining the best clinical networks and delivering quality customer service.  We have been retained us to recruit a Clinical Director, Dental.  This position will be based in the Atlanta Metro Area. 

 

The primary objective for this person is to provide clinical leadership and expertise in support of the company?s goal to provide access to high quality, cost effective dental care for its members.  Specific accountabilities:

? Management of the company?s professional claims review program and its relationship with outside professional review vendors.

? Oversight of the company?s corporate quality improvement program, including any state based programs in compliance with regulations.

? Provide clinical expertise in support of the following: provider credentialing, claims review appeals & utilization review.

? Assist the grievance & appeals department in the resolution of quality of care based on member grievances against participating dentists.

 

Ideal Qualifications:

? DDS or DMD with active dental license in good standing.

? 5 years experience in a similar Clinical role.

? First hand knowledge of developing claims review guidelines, including actual claims review experience at either a management or supervisory level is preferred.

? Understanding of dental benefits business required.

? High degree of emotional intelligence, flexibility, optimism and self-motivation. 

? Stellar communication skills; written, oral and presentation ready to reach a wide range of internal and external constituents.


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