Director, Provider Engagement DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

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:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The Opportunity:

The Director, Provider Engagement (PE) is responsible for overall provider network experience, performance and compliance. The Director strategically analyzes, manages, and reports on the provider network and related activities regarding all programs and products including Medicaid, Medicare Advantage, Marketplace, and Commercial (and any blend of products, e.g., dual eligible), and is responsible for the P&L (cost of care and loss ratio) of the network(s). These duties include but are not limited to the development and oversight of access, cost, and quality measurements to ensure network compliance, client satisfaction, sales support, optimized provider performance, and improved outcomes. The Director maintains ultimate oversight of as

signed provider engagement staff, and therefore provides clear direction, ongoing education to include professional development, and daily activity monitoring tools for reporting purposes. This position interfaces and collaborates with multiple internal operational areas, as well as face to face and virtually with clients, representing the organization as the network Subject Matter Expert.

How you will contribute:  

• Oversee the development and execution of, as well as provide support and direction to, the Provider Engagement team in support of all products

• Own applicable P&Ps, SOPs, SLAs and ensure compliance with them

• Develop innovative, competitive, cost effective and quality networks for all products in support of new sales and existing client retention

• Champion provider adoption/utilization of digital platforms/tools

• Provide support and direction to the team to ensure appropriate allocation of resources to meet multiple deliverables and participate in a wide range of network focused initiatives

• Establish provider network targets, recruit/contract new providers and work with existing providers to move them along the cost and quality continuum.

• Develop strategies to increase member access, preventive care, increase quality and outcomes, while decreasing costs

• Collaborate with other areas to ensure members assignments and dental home programs meet cost, quality, access and capacity goals

• Review and submit for approval special deal requests, retroactive adjustments, reimbursement, and contract exceptions

• Use available tools and resources to conduct Network Adequacy, Compliance, Validation, Accuracy, Appointment Availability, and other related activities as required/needed

• Collaborate with other enterprise functions to drive improvements in Provider Data Integrity

• Support and assist credentialing to obtain missing credentialing information

• Collaborate with Marketing, Communications, Governmental Relations, Clinical and Client teams to position the organization favorably and achieve desired business results

• Partner in responding to Request for Proposals (RFPs) to illustrate network strategies as a competitive advantage to grow new business and retain existing business

• Strategize with analytics and other teams on best approaches for col