Qualifications:

Education and Experience:

• 3 - 5 years of full-time experience (or equivalent) performing chairside dentistry required. 5+ years preferred.
• 3 - 5 years of workforce management experience and knowledge of effective. supervisory/management practices required. 5+ years preferred.
• Depth of understanding of the dental insurance industry, familiar with dental claims and the review process from the dentist and/or carrier side, and/or knowledge of CDT codes and ability/desire to ramp quickly in DDCO dental policy requirements.
• Active/current license, without restriction, to practice dentistry in the state of Colorado, or will obtain a Colorado Dental license within 60 days of employment.

Skills and Abilities:

• Knowledge of modern dental science practices, utilization review techniques, data/statistical analysis, practice protocols, and ADA issues.
• Strong verbal, written, and visual presentation skills using data and analysis required.
• Tech-savvy with experience in applying technology/software to improve processes preferred. Strong knowledge of Microsoft Office applications.
• Familiarity with dental quality assurance programs, oral health risk assessments, evidence-based community interventions and the criteria and standards used to monitor and measure patient outcomes preferred.
• Strong leadership presence and use of high energy, knowledge base, and refined interpersonal skills to influence strategy preferred.
• Excellent organizational and time management skills.
• Exceptional organizational and multitasking abilities with a keen attention to detail.
• High level of integrity and discretion in handling confidential information.
• Excellent interpersonal and communication skills.
• Strong problem-solving skills and the ability to adapt to changing priorities.
• Ability to work independently and collaboratively in a team environment.

Essential Functions

• Lead a team and organizational structure that oversees the daily operations of DDCO’s clinical management functions. Provide direction and supervision of department personnel, demonstrate professional judgment, use problem solving techniques and delegate appropriately.
• Provide leadership in the development of performance standards for all departmental personnel. Evaluate and counsel team members on their performance in a professional and timely manner. Plan and develop educational opportunities for the department as appropriate.
• Accountable for the hiring, training, directing and guidance of team members.
• Prepare annual budget and monitor concurrently. Monitor and analyze costs associated with staffing, travel, etc.
• Establish and maintain Clinical Management department playbook, workplans, and annual departmental goals ensuring alignment with DDCO strategy and mission.
• Identify and implement business process improvements to streamline and increase company and department efficiencies.
• Partner with Data & Analytics teams to develop department performance reporting capabilities & regularly report out on metrics to DDCO Leadership Council and Executive Leadership Team.
• Liaison to internal clinical-related committees
• Partner with Chief Dental Officer for special projects and with peers to ensure consistency and compliance with DDPA, DDCO, government programs, and other regulatory processing policies, claim review and adjudication processes.
• Partner with CDO to think through and integrate special projects like AI, VBCC Lite, etc. Work with clinical team and lead the calibration effort for DDCO.
• Oversee the research and analysis of dental practice patterns to ensure compliance with community and professional standards, monitor for and address fraud, waste, and abuse, up to and including on-site dental office audits.
• Partner with Sales & Client Services, Business Operations, and Claims Operations to align benefits and products with system capabilities, CDT code compliance, and DDPA standards.
• Develop clinical guidelines for processing dental claims and develop new products and benefits and innovative programs to increase utilization of dental benefits and quality improvement initiatives.
• Oversee the research and follow-up of concerns expressed by dentists and patients regarding dental procedures and claims processing policies.
• Assist with recruitment, training, and policy implementation for dental consultants.
• Actively manage/co-manage relationships with external vendors that provide value-added opportunities for clinical management efficiency, e.g., clearinghouse/attachment vendors, digital enablement (e.g. AI-powered claims review).
• Partner with Provider Relations leadership to build and maintain strategic relationships with various providers of dental services, including dentists, individual and corporate practices, independent dental hygienists, clinics, and medical providers.
• Collaborate with Delta Dental of Colorado Foundation, DDCO Marketing and Provider Relations’ teams to develop clinical education materials and ongoing campaigns that highlight the strengths and value proposition for participation in the Delta Dental network of providers locally and nationally.
• Leverage ongoing clinical data, reports, department trends and other analytics to support macro external communication and engagement to customer stakeholders.
• Provide regular clinical education and insight trends to internal team members to support education and awareness of DDCO’s mission and impact.

Working Conditions:

• This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, and photocopiers.
• Regular exposure to a computer screen.
• No physical effort beyond that is typically required in a normal office environment.
• Requires flexible time schedule. The potential for tight deadlines or time periods of high workload might require additional hours. Work on weekends or evenings may be required.
• Travel in and out of state may be required.
• This position is a hybrid role that requires three to five in the office based upon the needs of the organization.
• Ability to perform the essential functions of the job with or without reasonable accommodation.

Please note: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Salary Range: $169,291 - $211,224

Close Date: March 01, 2024

Delta Dental of Colorado offers a comprehensive compensation and benefits package. Some of the highlights from our benefits package include:

• Generous PTO
• 11 paid holidays
• 6 paid illness days
• Three affordable health plans
• Fantastic dental insurance plan
• 401(k) match with immediate vesting
• Supplemental retirement savings plan
• Company-paid life insurance, short-term disability, and long-term disability policies
• Wellness program
• Tuition reimbursement
• Transportation reimbursement (we are near a light rail station!)
• Paid volunteer time off

Delta Dental of Colorado is proud to be an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity, genetic information, military or veteran status, national origin, race, religion, sex, sexual orientation, or any other applicable status protected by state or local law.