Director, Utilization Management Professional

3 weeks ago


Milwaukee, Wisconsin, United States DentaQuest Full time

About the Role

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.
  • Manage department budget and oversee projects that improve efficiency and ensure resultant budgetary and performance goals are measured and achieved.
  • Represent the company to external stakeholders, including provider organizations, customers, advocacy groups, and government entities.
  • Develop and manage staffing models and operational processes to ensure analysis, data, reports, initiatives, and projects are completed accurately and efficiently.

Requirements

  • 10+ years of management/supervisory experience, with 5+ years of clinical experience in the dental industry.
  • Excellent research and analytic skills, with the ability to oversee, understand, and articulate the results of research and analysis.
  • Knowledge and understanding of regulatory language, managed care health plans operations, and HIPAA guidelines.
  • Excellent oral and written communication skills, with experience managing cross-functional projects.

About Us

DentaQuest is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. 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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