Senior Director, Dental – Medicaid
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Job Description
Senior dental leader guiding Liberty Dental Plan’s Medicaid clinical strategy. Overseeing utilization management, compliance, quality improvement, provider engagement, and clinical teams nationwide.
Responsibilities:
- Serve as the clinical authority for Medicaid dental utilization management across assigned markets
- Develop, review, and maintain clinical policies, utilization management criteria, and practice guidelines aligned with ADA standards, CMS requirements, and state regulations
- Lead, mentor, and support State Dental Directors, Staff Dentists, and clinical team members
- Facilitate clinical calibration exercises and quality review activities
- Participate in clinical governance committees and strategic organizational initiatives
- Oversee dental prior authorization, retrospective review, appeals, and utilization management programs
- Analyze utilization trends and identify opportunities to improve quality outcomes and healthcare affordability
- Guide staffing, training, calibration, and performance expectations for utilization management clinicians and reviewers
- Serve as clinical subject matter expert during audits, regulatory reviews, readiness assessments, and corrective action initiatives
- Partner with state agencies, regulators, and internal stakeholders on compliance requirements
- Monitor Medicaid regulations and drive operational improvements
- Provide expert clinical guidance on complex grievances, appeals, and escalated cases
- Lead initiatives improving access, health outcomes, member experience, preventive care, and value-based care
- Support care management programs and high-risk member outreach strategies
- Promote teledentistry and emerging care delivery models
- Collaborate with Quality Improvement teams on clinical performance and outcomes programs
- Serve as clinical liaison to provider networks, dental associations, academic partners, and key stakeholders
- Support provider education on utilization management criteria, coding requirements, benefit policies, and quality initiatives
- Participate in Medicaid procurements, RFP responses, market implementations, and expansion opportunities
- Partner with Clinical Performance, Analytics, and Actuarial teams to improve affordability and quality
- Help shape the clinical analytics roadmap and reporting strategy
- Support development of dashboards and reporting tools
- Leverage managed care principles and data-driven insights to improve clinical and financial outcomes
- Lead, coach, and develop high-performing teams
- Build stakeholder partnerships and influence cross-functional initiatives
- Partner with Quality, Analytics, Provider Relations, Operations, Compliance, Claims, Network Management, Product, and Member Services leaders
- Represent Dental leadership in executive-level discussions and organizational decision-making
Requirements:
- DDS or DMD degree from an accredited dental school
- Active, unrestricted dental license in at least one U.S. state
- Minimum of 12 years of clinical dental experience
- 3+ years of experience in utilization management, managed care, dental insurance, payer organizations, or Medicaid-focused healthcare environments
- 3+ years of people leadership, technical leadership, or functional management experience
- Proven success leading, coaching, and developing high-performing teams
- Deep knowledge of dental managed care, benefit structures, reimbursement methodologies, utilization management, and authorization workflows
- Experience developing clinical policies, managing utilization programs, and supporting regulatory compliance initiatives
- Strong understanding of Medicaid programs and government-funded healthcare environments
- Exceptional leadership, communication, relationship-building, analytical, and strategic thinking skills
- Ability to influence executive stakeholders and lead complex organizational initiatives
- Must be able to work within the United States
- No sponsorship or relocation assistance available
- Preferred: advanced degree in Public Health, Health Administration, Health Policy, Business Administration (MBA), or related field
- Preferred: experience leading multi-state Medicaid programs or national payer initiatives
- Preferred: experience collaborating with state Medicaid agencies and participating in regulatory audits
- Preferred: knowledge of value-based care models, provider performance management, and quality improvement strategies
- Preferred: familiarity with teledentistry and digital health solutions
Benefits:
- Competitive pay structure and savings options
- Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines
- Affordable medical insurance with low-cost premiums for employee-only coverage; Liberty subsidizes eligible dependent coverage
- 100% employer-paid dental coverage for employees and eligible dependents
- Vision insurance with low-cost premiums for employee-only coverage and dependents
- Company-paid basic life and AD&D insurance equal to one times base salary, with options to purchase supplemental coverage
- Flexible Spending Accounts for healthcare and dependent care expenses
- Voluntary accident, critical illness, and hospital indemnity insurance
- Long-term disability coverage
- Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts
- Employee Assistance Program (EAP) for mental health and well-being
- Generous vacation and sick leave policies, with ability to roll over unused time
- 10 paid company holidays
- Tuition reimbursement for eligible educational expenses
- Remote or hybrid work options available for various positions
- Potential bonuses
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