Job Description

Job Title: Chief Dental Officer
Job ID: 629052
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day
Facility:
Department: Medical Director Service
Location: 600 Grant St, Pittsburgh PA 15219

Description

The Chief Dental Officer for Medicaid Products reports to the CMO of Medicaid Services and is a key member of the UPMC Medicaid team.

Responsibilities:
  • Act as the subject matter expert for network development and fee schedule creation to support all Medicaid dental products; including expansion efforts and in provider based negotiations.
  • Attend and represent the Medicaid product and interact with officials at the state and national meetings as required.
  • Audit claims and patient charts as applicable
  • Chair appropriate committees as required for dental products and participate in various committees, including but not limited to: Quality Monitoring, Credentialing, and Fraud Waste & Abuse.
  • Create operational guidelines on clinical programs for systems; responsible for the applicable policies and procedures. Provide local expertise and be the face of dentistry in the UPMC Medicaid program to maximize the quality and efficacy of delivery services and to represent this program to appropriate payors.
  • Implement a robust clinical program for the Medicaid line of business, including utilization management and prior approval processes.
  • Optimize growth and financial performance in the Medicaid products
  • Responsible for dental strategy development, competitive analysis, product positioning, dental community promotion, and corporate governance of financial performance for Medicaid programs
  • Responsible for the implementation and oversight of the dental program for adults and children enrolled in Medicaid products.
  • Review and monitor provider corrective actions and site visits; perform site visits as necessary to address quality of care concerns.
  • Review authorization requests and associated documentation to uphold or overturn clinical decisions rendered by benefit examiners.
  • Review member complaints for medical exceptions and work the staff physicians on exception decisions.
  • Utilize experience to create offerings that distinguish UPMC Medicaid dental programs from competitors and improve competition of overall dental offerings.
  • Work with UPMC Health Plan Medical directors, UM, Quality, Complaints and Grievances, and the Special Investigations Unit to integrate the Medicaid dental and medical programs.
  • Work with compliance on the relevant state and federal specific regulations, including quality of care, supporting oversight and governance of the dental subsidiaries, product development, and key performance indicators.

Qualifications

  • Must be a graduate of an accredited Dental School (DMD/DDS) with a current license in the state of Pennsylvania in good standing. 
  • Maintain an unrestricted dental license. 
  • Must reside in the State of Pennsylvania 
  • Minimum of ten years of experience in an ancillary insurance product environment and execution at a management level 
  • Minimum of five years of practicing dentistry 
  • MBA Preferred 
  • Experience in administering Pennsylvania Medicaid and/or CHIP dental programs preferred 
  • Experience in utilization management review of dental and dental anesthesia claims 
  • Experience in detection and evaluation of dental fraud, waste and abuse 
  • Experience in developing and implementing dental prior authorization and payment policies 
  • Experience in implementing dental network quality improvement and incentive programs 
  • Experience in dental strategic planning 
  • Previous experience in managing complaints and grievances related to dental care
Licensure, Certifications, and Clearances:
  • Dentist
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

Share:
Talent Network