California Senior Manager, Provider Management, DentaQuest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Location: We support US flexible working arrangements in the contiguous 48 states.   

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America

The opportunity:  

The Senior Manager, Provider Partners provides guidance and oversight to Provider Partners regarding benefit programs, policies and procedures. The position is also responsible for identifying and addressing network gaps, recognizing and implementing process improvement opportunities, and monitoring CAP performance. This position is responsible for mentoring and coaching their team in provider recruitment and engagement.  In addition to managing staff, the role may also have responsibility for covering larger or more complex situations and markets.

How you will contribute:  

• Manage and Guide provider engagement staff

• Ensure provider engagement staff recruits providers within cost and access goals

• Authorize and negotiate special deals

• Develop strategic action plan to address network gaps

• Develop provider education curriculum and approach

• Cover more markets or highly complex markets

• Organize amendment and recruitment projects

• Develop project plans, internal/external reports, and ensure deliverables are met

• Identify and coordinate implementation of quality/cost improvements

• Manage reporting process to identify and modify provider outliers

• Provide cross-market support as needed

• Analyze and monitor provider performance reports

• Participate in and often present during client, organized dentistry and key stakeholder meetings/events

• Identify continuous improvement opportunities

• Manage CAP office performance

• Coordinate and implement appropriate performance management strategies for team members to include:

  • Assist in the hiring process, including interviewing candidates.

  • Assist, train and motivate team members.

  • Evaluate and measure effectiveness of team members.

  • Assist in preparation of performance and wage evaluations in accordance with company policy.

  • Responsible for attendance and company approved time off for team members.

  • Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives.

• Other duties as assigned

What you will bring with you:  

Required Qualifications:

• Bachelor’s degree in Business, H