Director of Utilization Management

6 days ago


Nashville, Tennessee, United States DentaQuest Full time
Job Summary

We are seeking a highly skilled and experienced Director, Utilization Management to join our team at DentaQuest. As a key member of our leadership team, you will be responsible for designing, planning, developing, implementing, and administering all aspects of our utilization management programs.

Key Responsibilities
  • Develop and maintain a high-value utilization management program that ensures members receive high-quality and appropriate clinical care in a timely and cost-effective manner.
  • Collaborate with internal departments to implement strategies and programs to proactively manage dental utilization costs within each market to ensure profitability and budgetary goals are met.
  • Oversee and direct utilization management department personnel and metrics to ensure compliance with business unit objectives.
  • Develop and manage staffing models and operational processes to ensure analysis, data, reports, initiatives, and projects are completed accurately and efficiently to meet organizational and client needs.
  • Provide recommendations on department policies, objectives, and initiatives, and evaluate and suggest changes as necessary to optimize processes and efficiencies.
Requirements
  • 10+ years of management/supervisory experience
  • 5+ years of clinical experience in the dental industry (preferred)
  • Research and analytic skills, or ability to oversee, understand, and articulate the results of research and analysis
  • Knowledge and understanding of regulatory language
  • Excellent oral and written communication skills
  • Experience managing cross-functional projects
  • Knowledge of managed care health plans operations and HIPAA guidelines
  • Intermediate computer skills
What We Offer

We offer a competitive salary range of $142,200 - $240,300 annually, depending on location. In addition to salary, this position is eligible for incentive awards based on individual and business performance, as well as a broad range of competitive benefits.

We strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.


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