TX Regional Dental Director

Role Summary: This individual should be passionate about Cigna Dental, clinical dentistry, and contributing to our continued success. This person should be a leader who will join a team that is dedicated to excellence as we deliver innovative, cost-effective programs designed to improve the health of our customers. This individual will help us to develop outstanding, long-term, mutually beneficial relationships with all stakeholders—including healthcare professionals and clients, and well as our colleagues.Responsibilities :Clinical Leadership and Support / Implementation of Quality - Provide clinical leadership and support at the regional level. Manage effective DHMO and PPO Quality Management Programs (QMPs) at the regional level to meet regulatory needs and add business value.

Work directly with dental health care professionals to address issues, as appropriate.

Act as clinical lead on customer and provider complaints and appeals, as requested. Manage the development of corrective actions at the member and provider level for quality of care grievances in the region.

Coordinate with professional relations and services to resolve provider issues.

Manage the following within targets to meet regulatory requirements and add business value:Meet regulatory compliance through successful audits without fines or penalties. Participate in state audits as the state Dental Director.Ensure effective provider monitoring including Performance Monitoring, regional Grievance Subcommittee, regional Utilization Management Subcommittee, and regional Peer Review Subcommittee activities, as appropriate.Timely and thorough follow up on all charting and clinically based Periodic Quality Assessment deficiencies when appropriate. Network Clinical Periodic Quality Assessment (PQA) follow-up incidents > 90% closed in 30 days.Support review and enhancements to the Periodic Quality Assessment Process as part of the Quality Management Program. Work with the Quality team to execute the PQA process.Credentialing/Re-credentialing – Chair the regional Credentialing Committee and provide clinical/quality leadership over the review and decision making for our DPPO and DHMO products to enhance network quality, maintenance, and growth.Effectively contribute as the clinical lead for the region by responding to requests within 48 hours.Support leadership and/or participation in meetings, minutes, and work plans for timely completion.

Serve as the specific state Dental Director to comply with state specific regulations.

Conduct any state specific Dental Director responsibilities to meet regulatory compliance.

Provide input regarding changes to state level QMP descriptions.

Clinical Support for Sales - Maximize sales opportunities and results through participation in finalist, renewal presentations, as requested by Regional Leads, Sales, and Clinical Leadership.

Participate in finalist presentations, key client retention meetings, broker meetings, open enrollments, health fairs, and health promotion activities as requested by sales or client management to support growth and retention.

Enhance clinical reporting capabilities for clients and support efforts to meet established UM Initiatives

Emphasize the value of our whole person health, integrated programs and Quality Management Program

Demonstrate our responses to clinical innovations that further differentiate Cigna Dental from our competitors.

Provide dental education presentations to the internal teams as requested.

Provide consultation to Proposal Management, within the negotiated timeframes, for the development and maintenance of content that most accurately reflects Cigna’s capabilities and competitively positions Cigna to external audiences.

Clinical Input and Support for Organization Projects - Participate in projects and workgroups to enhance product/program offerings to customers, achieve process improvements, and to develop clinical recommendations appropriate to achieve organizational targets.

Active clinical support for annual CDT Workgroup activities

Active clinical support for the on-boarding, credentialing, re-credentialing, and delegated credentialing processes

Active clinical support for the development of new product and program offerings.

Active clinical support with research and/or data analysis to provide proof points and validation of clinical programs

Active clinical input and support for the Oral Health Integration Program. Support clinical integration projects as appropriate

Active clinical support for value-based reimbursement programs developed to promote quality of our dental networks.

Active clinical input and support for review and assessment of new technology and innovations.

Clinical Policy - Assist Clinical Leadership in the development and maintenance of national policies and guidelines. Assist in product development as requested.

Contribute to a thorough analysis and evaluation, in order to determine the business value, including cost analysis. Develop appropriate, sound recommendations whether or not to implement the proposed new benefits/ benefit enhancements.

Evaluate existing Cigna Dental policies and benefits. Make recommendations for maintaining current benefits and policies, or modifying them based on emerging trends and evidence based dentistry.

Continue to improve ease of doing business with Cigna Dental through policy simplification, thereby enhancing provider and customer satisfaction.

Evaluate and make recommendations to improve affordability, claims processing and increase auto-adjudication through review of claims processing policies.

Research, develop, and document clinical positions on appropriate topics to support coverage positions and recommendations for plan designs and programs.

Provide active support in the development of Dental Consultant manuals to assist in accurate clinical claims review.

Provide clinical leadership and support for the implementation of annual changes to the ADA CDT Code.

Participate in the review and periodic updating of DPPO and DHMO Dental Office Reference Guides to meet business and regulatory needs.

Participate in the review of annual DPPO and DHMO Clinical Coverage Guidelines documents.

Qualifications:

DDS or DMD required and an active licensure in the state of Texas

Must reside in the state of Texas.

3-5 years of experience as a Dental Director

Minimum 5 years of experience in clinical practice.

ADA membership is preferred (not required).

Must be detail oriented, highly organized, deadline driven, and self-motivated

Must possess project management expertise with demonstrated experience in managing multiple projects and priorities

Excellent interpersonal skills. Capable of working and communicating well in a matrixed environment with Dental Directors, Sales, Dental Professional Relations; National Appeals Unit, Credentialing, Legal, Policy and Compliance, Healthcare, Service Operations, Marketing; as well as state regulators and auditors

Excellent oral and written communication skills are required.

Experience managing team members.

Skilled in the use of Microsoft Word, Excel, PowerPoint, and Outlook.

Capable of quickly learning and mastering the intricacies of a variety of IT systems

Experience in the various aspects of a strong Quality Management Program

Strong background in the Credentialing and Re-credentialing of dentists

Excellent analytical, quantitative, and problem solving skills

Knowledge of NCQA, DQA and other medical/dental quality standards and state specific regulations regarding quality programs.

Command of dental terminology, clinical procedures, and benefit language.

Financial acumen for assisting in financial analysis. Demonstrates an ability to analyze financial data.

Demonstrates the ability to work collaboratively to resolve conflicts.

Excellent public speaking and presentation skills, matrix management and collaborative teamwork experience preferred.

Have the ability to handle multiple, new, and unanticipated responsibilities that arise as a result of tactical and strategic planning

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an annual salary of 145,400 - 242,300 USD / yearly, depending on relevant factors, including experience and geographic location.This role is also anticipated to be eligible to participate in an annual bonus plan.We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.