East Regional Dental Director - Remote

JOB DESCRIPTION: DENTAL DIRECTOR

This individual should be passionate about Cigna Healthcare Dental & Vision, clinical dentistry, and contributing to our continued success.

This person should be a leader who will join a team that is dedicated to excellence as we deliver innovative, cost-effective programs designed to improve the health and vitality of our customers.

This individual will help us to develop outstanding, long-term, mutually beneficial relationships with all stakeholders, including healthcare professionals and clients, and well as our colleagues.

Responsibilities:

1.

Clinical Leadership and Support / Implementation of Quality - Provide clinical leadership and support at the regional level.

Manage effective DHMO and PPO Quality Management Programs (QMPs) at the regional level to meet regulatory needs and add business value.


* Work directly with dental health care professionals to address issues, as appropriate.


* Act as clinical lead on customer and provider complaints and appeals, as requested.


* Manage the development of corrective actions at the member and provider level for quality-of-care grievances in the region.


* Coordinate with professional relations and services to resolve provider issues.


* Manage the following within targets to meet regulatory requirements and add business value:
+ Meet regulatory compliance through successful audits without fines or penalties.

Participate in state audits as the state Dental Director.
+ Ensure effective provider monitoring including Performance Monitoring, regional Grievance Subcommittee, regional Utilization Management Subcommittee, and regional Peer Review Subcommittee activities, as appropriate.
+ Timely and thorough follow up on all charting and clinically based Periodic Quality Assessment deficiencies when appropriate.

Network Clinical Periodic Quality Assessment (PQA) follow-up incidents > 90% closed in 30 days.
+ Support review and enhancements to the Periodic Quality Assessment Process as part of the Quality Management Program.

Work with the Quality team to execute the PQA process.
+ Credentialing/Re-credentialing - Chair the regional Credentialing Committee and provide clinical/quality leadership over the review and decision making for our DPPO and DHMO products to enhance network quality, maintenance, and growth.
+ Effectively contribute as the clinical lead for the region by responding to requests within 48 hours.
+ Support leadership and/or participation in meetings, minutes, and work plans for timely completion.



* Serve as the specific state Dental Director to comply with state specific regulations.


* Conduct any state specific Dental Director responsibilities to meet regulatory compliance.


* Provide input regarding changes to state level QMP descriptions.

2.

Clinical Support for Sales - Maximize sales opportunities and results through participation in finalist...