For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Role OverviewThe Dental Director will have oversight of the District of Columbia, Delaware, and Marketplace Plans. In this role, you will develop and lead the dental strategy to meet state requirements, incorporating oral health prevention and treatment into the Plan's population health efforts and the delivery of holistic, person-centered, integrated care. Ensures dental benefit operates in compliance with standards of dental care. Oversee performance on dental measures. Oversee utilization management of dental benefits to ensure members receive timely, appropriate, and medically necessary dental care.
• Works collaboratively with medical, behavioral health, pharmacy, population health, quality, network, compliance, vendor oversight, and state agency partners to advance oral health outcomes, improve member experience, and ensure compliance with state, federal, contractual, and accreditation requirements.
• Provide clinical oversight of dental benefits to ensure services are delivered in compliance with applicable standards of dental care, contractual requirements, regulatory expectations, and accreditation standards.
• Oversee performance on dental quality and access measures, including development and monitoring of improvement strategies to close gaps and improve member outcomes.
• Partner with provider network, provider relations, and vendor partners to support dental provider recruitment, access expansion, provider education, and service delivery capacity.
• Serve as a clinical dental subject matter expert for internal teams, external partners, providers, committees, audits, regulatory reviews, appeals, grievances, and quality improvement activities.
• Support development, implementation, and maintenance of dental policies, procedures, provider guidance, clinical criteria, and operational workflows.
• Participate in audit readiness, regulatory reporting, accreditation activities, compliance reviews, and remediation efforts related to dental benefits and services.
• Use data, quality indicators, provider feedback, member experience insights, and utilization trends to inform dental strategy, program design, and continuous improvement.
• Promote preventive dental care, early intervention, member engagement, and oral health education strategies that improve long-term health outcomes.
Work Arrangement- Must work in our office located at 1201 Maine Ave SW in DC
- Monday through Friday, 8:30 AM EST to 5:00 PM EST
Education and Experience- Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM) degree from an accredited dental school
- Minimum of 5 years of clinical dental experience, preferably including Medicaid, managed care, public health, dental benefit administration or care delivery for underserved population
- Experience working with dental providers, provider networks, state agencies, vendors, or cross-functional health plan teams
- Experience in a Medicaid managed care organization, dental benefits administrator, public health program, or value-based care environment
- Experience leading dental quality improvement initiatives, provider education strategies, access improvement efforts, or vendor oversight activities
- Utilization management or dental claim/authorization review experience desired
Licensure- Must possess an active and unencumbered license to practice dentistry in the District of Columbia
Skills and Abilities- Knowledge of Medicaid managed care, dental utilization management, medical necessity review, quality improvement, regulatory compliance, and standards of dental care
- Familiarity with NCQA, HEDIS, EPSDT, state Medicaid contract requirements, member appeals and grievances, and prior authorization processes
- Strong clinical judgment and knowledge of evidence-based dental standards of care
- Ability to interpret and apply Medicaid contractual, regulatory, accreditation, and compliance requirements
- Strong analytical skills with the ability to evaluate utilization trends, quality metrics, access data, and performance results
- Excellent verbal and written communication skills, including the ability to present clinical and operational information to executive, regulatory, provider, and cross-functional audiences
- Demonstrated ability to collaborate across medical, behavioral health, pharmacy, network, quality, compliance, operations, and vendor teams
- Ability to influence, lead, and drive improvement in a matrixed managed care environment
The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the DC area.
Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.
AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.
The targeted hiring range for this role is expected to be between $167,600.00 and $277,300.00.
