Dental Hygienist II

2 months ago

Austin, United States Texas Department of Aging & Disability Services Full time
Job Description:
Dental Hygienist II

The dental hygienist for the Medicaid and CHIP Services Department (MCS) serves as a dental clinician in the Office of the Medical Director (OMD). MCS is driven by its mission to deliver quality, cost-effective services to Texans. OMD provides clinical consultation and guidance to other areas within MCS, throughout the Agency, and to external stakeholder organizations. It works to provide a clinical vision for improving the health of Texans by aligning MCS programs with state public health priorities. OMD also leads the utilization review team of MCS which is charged with ensuring that individuals receive medically necessary, cost-effective services.

This position reports to the Dental Director for MCS. The work involved is advanced (senior-level) dental consultive work to include integrated knowledge of the Medicaid/CHIP programs with up-to-date dental practices and evidence-based clinical guidelines. This critical work helps to shape policies and the delivery of comprehensive healthcare, to include dental services, to children and adults served by HHSC. The position performs advanced administrative, consultative, and managerial work to include advising staff on unusual or difficult/clinical issues. Work also involves planning and coordination of dental programs and activities in close consultation with the Dental Director and other HHSC staff within MCS. This includes assisting in articulating a vision for the advancement of dental services for Medicaid and CHIP Programs.

Duties include providing dentistry-related training and the provision of technical assistance to HHSC staff. The dental hygienist provides clinical guidance and interpretation of HHSC policy through review of rules and standards. The position interfaces with a variety of stakeholders and stakeholder organizations to include providers, advocates, advisory committees, legislators, and other policymakers. This position interfaces with relevant staff from other state agencies (e.g. Department of State Health Services, HHS Office of the Inspector General), vendors, contractors (e.g. TMHP), and Dental Maintenance Organizations (DMOs).

This position works under limited supervision with considerable latitude for the use of initiative and independent judgement.
The ideal candidate thrives in an environment that emphasizes teamwork to achieve goals, excellence through high professional standards and personal accountability, curiosity to continuously grow and learn, critical thinking for effective execution, and integrity to do things right even when what is right is not easy. Essential Job Functions:
45% Serves as a key dental clinical subject matter expert across Medicaid and CHIP programs. Provides clinical guidance and technical assistance for the development, updating, and improvement of dental benefit policy for both children and adults. Serves as a dental subject matter expert for HHSC dental education efforts. Provides professional review of proposed dental service plans as it relates to adult clients in waiver programs. Contributes to the review, notifications, and updating of the dental sections of the Texas Medicaid Provider and Procedures Manual (TMPPM) on a monthly basis. Provides technical assistance and consultation on dental managed care contracts, DMO operational reviews, and dental readiness activities. Provides clinical guidance with analysis of legislation, legislative implementation, and litigation, as needed. Collaborates across many HHSC departments related to fee schedules, claim adjudications, prior authorizations, dental quality measures and general oversight of dental managed care issues. Provides clinical guidance to the Provider Finance Department on reviews of dental fees.

20% Provides clinical guidance and technical assistance in the development of external-facing trainings on oral health/dental topics.

20% Analyzes data, identifies discrepancies in benefit policies, and makes recommendations to improve child and adult oral health and dental outcomes. Works with the Managed Care Contracts & Oversight (MCCO) team to identify, research, and resolve complaints and concerns involving Medicaid dental providers as well as clients.
10% Travels as needed. Attends key Medicaid/CHIP oral health/dental internal and external stakeholder meetings. Such activities may include meetings with the dental directors from DMOs, dental/oral health staff at other state agencies, as well as key stakeholder groups such as the Texas Dental Association and the Texas Academy of Pediatric Dentistry.

5% Conducts special projects or other duties as assigned in support of the Medicaid and CHIP Services Division. Knowledge Skills Abilities:
Knowledge of state and federal laws and regulations related to dental and oral health programs to include the Texas Health Steps program.

Knowledge of program planning, implementation, and evaluation.

Knowledge of local, state, and federal laws and regulations and of the principles of public administration and management.

Knowledge of the Medicaid Program and Children's Health Insurance Program to include Medicaid waiver programs.

Knowledge of and expertise in the clinical practice guidelines development process.

Ability to understand and effectively interpret agency and program rules, policies, and procedures.

Ability to lead a multi-disciplinary team.

Ability to perform policy and dental/oral health literature research.

Ability to write medical and program policy.

Ability to communicate effectively orally and in writing.

Ability to coordinate activities among public, private, and professional groups.

Ability to exercise judgment in evaluating situations and making decisions.

Skill in problem identification, analysis, and resolution.

Skill in policy development, implementation, and evaluation
Skill in process facilitation techniques, team-building, conflict resolution, and strategic planning.

Skill in the use of computer software, specifically Windows, Microsoft Outlook, Word, Excel, and Power Point.

Skill at establishing and maintaining productive working relationships both internally and externally.

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