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, renewal presentations, as requested by Regional Leads, Sales, and Clinical Leadership.

• Participate in finalist presentations, key client retention meetings, broker meetings, open enrollments, health fairs, and health promotion activities as requested by sales or client management to support growth and retention.

• Enhance clinical reporting capabilities for clients and support efforts to meet established UM Initiatives

• Emphasize the value of our whole person health, integrated programs and Quality Management Program

• Demonstrate our responses to clinical innovations that further differentiate Cigna Healthcare Dental from our competitors.

• Provide dental education presentations to the internal teams as requested.

• Provide consultation to Proposal Management, within the negotiated timeframes, for the development and maintenance of content that most accurately reflects Cigna’s capabilities and competitively positions Cigna to external audiences.

3. Clinical Input and Support for Organization Projects - Participate in projects and workgroups to enhance product/program offerings to customers, achieve process improvements, and to develop clinical recommendations appropriate to achieve organizational targets.

• Active clinical support for annual CDT Workgroup activities

• Active clinical support for the on-boarding, credentialing, re-credentialing, and delegated credentialing processes

• Active clinical support for the development of new product and program offerings.

• Active clinical support with research and/or data analysis to provide proof points and validation of clinical programs

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