Vice President of Dental Services

 GENERAL SUMMARY

The Vice President of Dental Services for DDMN provides professional leadership, strategic direction and clinical oversight. In addition, this Clinician works closely with the Vice President of Dental Services for DDNE in oversight of activities associated with dental policy development and implementation, Utilization Management (UM), Quality Improvement (QI) activities, provider credentialing, provider practice ethics, and clinical support of network management. The clinical team works together to ensure and promote the provision of appropriate, high quality, cost effective oral health care to decrease costs and increase value for subscribers/members and purchasers.

This position leads the Clinical Team and is part of the Insurance Division executive team that is responsible to provide team members, executive leadership and the DDMN Professional Review and Relations Committee of the Board of Directors with information about oral health policies, practices and effectiveness. This position may also provide reports to the Board of Directors. 

This positions may be full-time or part-time (.80). 

ESSENTIAL FUNCTIONS

1. Assume a leadership role in the growth of the DDMN provider network through recruitment strategies.  Oversee the management of the DDMN network.
2. In partnership with the Vice President of Dental Services DDNE, establish dental management goals for the insurance division and oversees the clinical policy, and the development, implementation, maintenance and enhancement of clinically related programs, activities and procedures. 
3. Champion a culture of excellence around all responsible functions including deepening provider relations, utilization management, quality improvement, dental policy, practice ethics, and network development.
4. Represent Delta Dental to external customers and key stakeholders including, but not limited to, Minnesota Dental Association, regulators, providers, other Delta Dental plans, educators, policy-makers and industry leaders to influence policies and relationships to further the mission of the company and strategic plan.
5. Present lectures and presentations to educate key stakeholders, both internal and external, on current science and research and to strengthen the message of Delta Dental's mission.
6. Oversee and coordinate UM analytics to maximize the corporation's competitive advantage and to maximize resources in the most efficient and cost-effective manner.  Continuously assess and modify the UM processes and protocols to ensure current analytics meet corporate needs.
7. Works with the Compliance Department to ensure the fraud and abuse prevention and detection program serves the best interests of the corporation, purchasers and members by being (1) based on the most current scientific evidence and scientifically-based clinical knowledge, (2) implemented via appropriate analytical and clinical methodologies.
8. Review clinical requirements set by DDPA and implement in coordination with the Vice President of Dental Services DDNE and the Chief Actuary for impact to dental fees, as appropriate.  This includes annual update of CDT codes and Processing Policies, review of DDPA statements, dissemination/implementation of wellness products, and credentialing requirements.  Coordinate and assist in operationalization of DDPA activities and requirements with appropriate Delta Dental departments.
9. Provide clinical oversight and expertise to understanding and implementing compliance activities to meet regulatory requirements for DHS, CMS, HIPAA and other Federal, State and Local entities by working closely with both the Legal team and the Compliance Officer.
10. Design, collaborate, implement, monitor and evaluate oral health and health research, and facilitate its application in product, network and data management designs and offerings. Ensure that all research activities are conducted using scientifically accurate research principles and methods.
11. Disseminate research findings at major national professional meetings and in published peer-reviewed journals.
12. Contribute professional and clinical input into structuring benefits and marketing products so they are consistent with current oral disease patterns and scientifically based dental practice.
13. Work closely with other key operating department leaders to develop new products, markets and technologies as well as assist with key initiatives by providing clinical expertise.
14. Educate purchasers, members, providers and the public regarding the changing nature and distribution of oral diseases and conditions and the benefits/services necessary to address these changes so that dental professionals provide, and patients choose appropriate, cost-effective oral health services.
15. Formulate analytical and clinical strategies to coordinate and monitor the appropriateness and cost effectiveness of oral health services.  Facilitate the use of data to measure and monitor provider practice patterns and utilization to meet strategic goals.
16. Provide information and respond to inquiries regarding the functions, responsibilities, and activities of UM Team to corporate staff, purchasers, the health care benefits industry and the public.  Oversee development of materials that are used to explain the functions and activities of UM Team.
17. Provide value-added support to sales and marketing efforts through participation in sales presentations.  Develop presentations for clients on the medical-dental connection and the importance of oral health to overall health including logs for the Delta Dental website.
18. Work with the Vice President Dental Services DDNE to create a theme for the annual Symposium and work with Marketing to select speakers.  Assist in Outreach to Provider Network and other outside stakeholders to promote Delta Dental events such as the Star of the North, the North Dakota Dental Association Annual meeting and other events.
19. Oversee professional dental consultation for the design and implementation of oral health education activities for subscribers/members, providers, purchasers and the public that will lead to enhanced economic value and oral health improvement.  Assist with the creation of educational tools and other resources that may be used in educating targeted audiences by tailoring the materials to the audiences' level of understanding and need.
20. Oversee professional and clinical leadership for dental utilization management and clinical quality improvement activities to meet the strategic needs of the corporation.
21. Prepare materials for the Professional Review and Relations Committee (PRRC) working closely with the Vice President Dental Services DDNE and the clinical team.  Together with the Vice President Dental Services DDNE, review meeting agendas with the Chair of the DDMN and DDNE PRRC Committee.
22. Partner with Vice President of Dental Services DDNE, operations and legal to oversee investigation, evaluation and documentation of Quality of Care grievances filed by members. Partner with Vendor management in oversight and coordination of activities with corporate and vendor personnel responsible for tracking grievances, dental offices and government programs staff to facilitate resolution.
23. Provide oversight for development of Annual QI Plan and annual review of the QI Plan and present to the QI Committee for approval.  This is provided to PRRC for formal approval.
24. Provide oversight for development of Annual UM Plan and annual review of the UM Plan and present to the UM Committee for approval.  This is provided to PRRC for formal approval.
25. Participate with vendor management in annual oversight audits of vendors with delegated activities to ensure the vendor meets or exceeds performance standards and follows processes and protocols in coordination with the vendor oversight team.
26. Respond to requests from internal Provider Advocate staff, consultants, providers, and members regarding the review of complex or unusual pre-estimate of benefits prior authorization requests or claims to assure that the corporation's professional clinical review activities are in compliance with corporate policies and procedures and purchasers' contracts. 
27. Provide oversight for clinical appeals and clinical matters involving professional knowledge and input.
28. Chair the QI Committee to provide clinical information to establish, maintain, and revise, as necessary, QI policies and procedures to meet the needs of the corporation, purchasers and members.
29. Chair the UM Committee to provide clinical information to establish, maintain, and revise, as necessary, professional review policies and procedures to meet the needs of the corporation, purchasers and members.
30. Chair the Credentialing Committee to provide professional insight and advice regarding specific identified provider actions that influence the adjudication of the credentialing and re-credentialing processes.
31. Complete special projects as assigned, including but not limited to, project management assignments, development and implementation of training to meet internal and external needs, meeting with providers about special concerns, responses to requests for proposals, speaking at seminars and forums, writing oral health related blogs, attending dental benefits industry meetings as assigned, compiling data for strategic planning, conducting research and developing materials for Board presentations. 
32. Participates in internal and external audits.
33. Provide analysis to ensure compliance with Delta Dental Plan Association mandates and product regulatory requirements.
34. Play the lead role in attracting, hiring, and retaining top clinical talent.
35. Special projects as assigned.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES

This job requires candidates to be able to perform duties that include the following:

1. Ability to develop, manage and build teamwork among diverse constituencies both within and external to the corporation
2. Understand drivers of dental health care costs and ability to apply clinically and scientifically appropriate solutions to address and mitigate the same
3. In-depth knowledge of dental health care benefits industry, products, consumer market, competitive environment, current practice trends and legal/legislative climate
4. Strong professional technical knowledge of patient and disease management operations and activities
5. Understanding of dental benefits in relationships to pricing and underwriting
6. Extensive understanding and proficiency in the use of metrics and statistical methods in managing programs, services and activities
7. Ability to apply research to business processes
8. Knowledge of professional regulatory requirements
9. Ability to communicate complex concepts or policies verbally or in writing
10. Skilled public speaker who effectively communicates clinical and dental benefits industry knowledge to internal and external groups
11. Ability to understand and analyze policies and their implications to the corporation and to the public at large
    1. Ability to negotiate with tact and diplomacy and deal with adversarial situations
    2. Self-motivated and able to work independently
    3. Organizational skills to keep multiple projects meeting deadlines and requirements
    4. Excellent problem solving, analytical, oral and written communication skills.
    5. Interpersonal skills to deal with a variety of people and the professional demeanor to represent the company to external contacts

REQUIRED EDUCATION AND EXPERIENCE

1. Must be a graduate of an accredited dental school, having attained a D.D.S./D.M.D. degree and have an active dental license in good standing.
2. A dental clinical background is necessary with 10 or more years of dental/clinical experience preferred.
3. Oral Health Insurance related experience preferred.
4. Proven ability to exercise good judgment and make independent decisions.

RELATIONSHIPS

1. Reports To: President, Delta Dental of Minnesota
2. Directly Manages: Clinical Team (Dental Hygiene Team Members)
3. Internal Relationships: VP of Dental Service - DDNE, Insurance Division Leadership, Executive Leadership, Sales and Account Management Leadership and team members, Other Finance Management and team members and all levels of personnel from other corporate divisions. 
4. External Relationships: External contacts are frequent and wide-ranging including providers, representatives of the health benefits industry, Minnesota Dental Association leadership, educators, consultants, clinical researchers, DDPA staff, personnel from other Delta Dental Plans, outside legal counsel, regulatory authorities, customers and vendors.