For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The UHC Community Plan of PA Dental Director is a dentist or dental hygienist, who manages customer facing clinical aspects of Dental Government programs in PA, primarily Medicaid and CHIP. The Director will serve as the dental clinical representative of UHC Community Plan of PA to the DHS Chief Dental and Medical Officers, other government officials, regulators as well as internal clinical, quality and operational teams serving both the Health and Dental plans. The Director will participate in state directed activities related to claim review, utilization review and management, quality review and management, as well as quality improvement projects related to disease management and wellness, designed to increase overall access and utilization of preventive services. The position will also support UHC Community Plan of PA in securing new business and support underwriting during plan set-up. Primary Responsibilities: Serve as the liaison to the state regulators for all clinical based requests and provide a government focused clinical presence for existing and new programs Develop and implement clinical best practices for all the Community Plan's clinical dental programs, including: Improving access to dental care through implementation of education and outreach strategies, (as evidenced by meeting HEDIS Annual Dental Visit targets) Increasing rates of preventive utilization, consistent with the CMS Oral Health Initiative Partnering with the Health plan on Medical-Dental Integration strategies and programs (ex. ECC / physician varnish programs, ER diversions program) Working with Quality Management to implement and monitor Performance Improvement Projects (PIPs) designed to support clinical objectives Participating in development and implementation of dentist pay for performance initiatives Engaging in development of alternative practice models, ex. deployment of public health hygienists, school based health, mobile dentistry, teledentistryDrive timelines and deliverables for all clinical programs through coordination with Dental Plan colleagues Represent as the clinical leader of government programs for policies and procedures related to utilization management, quality improvement, appeals & grievances Collaborate with UHC Community Plan's Chief Medical Officer in the development and implementation of clinical initiatives, plan design and benefit questions, utilization or quality of care concerns Identify and source opportunities to creatively partner with the HP's Clinical and Quality teams on clinical initiatives focused on provider engagement and education tactics (e.g., physician varnish, the importance of seeing very young children, the value of sealants etc.) Work with the Health Plan QM team in the development of annual QI programs Engage in advocacy activities, including participation in the Pennsylvania Coalition for Oral Health Work with other dental clinicians in supporting strategies for clinical program development, UR and QM Support the marketing and sales of dental government programs in PA, including consultation for benefit design and producing RFP responses Develop policies and procedures related to clinical management and develop SME on local laws / guidelines governing clinical programs Prepare presentations and reports as needed summarizing clinical activities Coordinate and lead local peer review committees as appropriateKeys for success in this position include excellent interpersonal skills, the ability to drive change, influence individuals, taking appropriate risks and consensus building as well as the ability to empower and motivate others, and excellent oral and written communication and problem solving skills. Additionally, this position will require strong planning, organizational and analytical skills
Required Qualifications: Dental or dental hygiene degreeActive PA dental or dental hygiene license 7+ years clinical experience, with experience in treating Medicaid patients desirable 5+ years dental managed care or dental insurance experience Intermediate level of PC proficiency, including PowerPoint, Excel and AccessPreferred Qualifications: Experience working for FQHC, dental insurance carrier, academic institution, or organized dentistry Specific experience with Government dental programs Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Dental Director, UHC, Community Plan of PA, Pennsylvania, Philadelphia
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.