Job Description

Job Title: Dental Director / Clinical Advisor

Work Type: Full-Time

Work Location: San Diego, Ca Only

Job Family: Healthcare Services and Operations

Position Overview:

• The Dental Director / Clinical Advisor provides leadership, direction, and clinical expertise for dental programs. This role supports care management, population health, and integration of medical and dental services to improve overall health outcomes. The position includes oversight of dental service vendors, policy evaluation, compliance with regulations, and participation in strategic initiatives to enhance dental care delivery.

Key Responsibilities:

• Provide clinical oversight for dental programs and vendors.
• Develop and review utilization metrics and ensure integration between medical and dental care management.
• Evaluate existing dental benefits and policies; recommend updates based on trends and evidence-based practices.
• Analyze and recommend new dental benefit enhancements with cost and business impact assessments.
• Serve as a subject matter expert on dental programs, product strategy, emerging technologies, and public policy.
• Review and assess emerging dental and medical integration research.
• Participate in compliance and vendor quality committees and ensure adherence to regulatory requirements.
• Perform clinical reviews for prior authorizations, appeals, grievances, and other dental services.
• Provide input based on appeals and grievance trends to improve care and compliance.
• Support enterprise advocacy efforts to enhance member health and cost outcomes.
• Participate in client, broker, and consultant meetings to support retention and growth initiatives.
• Attend required compliance and professional development sessions.
• Ensure all work complies with state and federal regulations.

Qualifications:

• Doctor of Dental Science (DDS) or Doctor of Dental Medicine (DMD).
• Completed dental residency training.
• Active, unrestricted dental license in the state of California (required).
• Board certification through the American Board of Dental Specialties (ABDS) or American Board of General Dentistry (ABGD) preferred.
• Minimum 5 years of post-residency clinical experience.
• 5 years of managed care experience preferred (utilization management, case management, or quality improvement).
• Strong knowledge of Medicare , California statutes , DMHC regulations , and NCQA accreditation standards preferred.
• Understanding of social determinants of health and psychosocial factors affecting care.
• Ability to work independently and make sound decisions in complex or ambiguous situations.
• Strong leadership and communication skills, with the ability to collaborate across multidisciplinary teams.
• Excellent written, verbal, analytical, and organizational skills.
• Proficiency in Microsoft Office applications (Excel, Outlook, Word, PowerPoint).

Additional Information:

• Must comply with all applicable state and federal healthcare regulations.
• Participation in compliance and corporate training is mandatory.
• Opportunities for professional growth and engagement in clinical and operational strategy initiatives.

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