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Requisition Number: 1241
Job Title: Assistant Dental Director
Number of Positions: 1
Position Type:
Area of Interest: Professional Services
City: Little Rock
State / Province: Arkansas
Job Description: Job Summary: Oversees a variety of dental programs in the Professional Relations department and supervises all dental consultants including their training and performance. The Dental Director oversees utilization review policies, protocols and determinations and reviews certain dental claims from a clinical perspective to determine benefits allowed based upon guidelines of the group contract.

Primary Job Responsibilities:

1. Ensures that Delta Dental of Arkansas meets Utilization Review Accreditation Commission standards (URAC) to include evaluation of URAC requirements, development of written policies and procedures, creation of necessary work flows, and education and training of workforce. Will serve as project lead if URAC accreditation is pursued.
2. Implements and monitors the operations of the Prior Authorization program for the Smiles program. Coordinates development of policies for dental claims evaluation to determine appropriateness of treatment.
3. Chairs and/or participates in various committees as assigned by the Vice President.
4. Coordinates reporting and data analysis needed in the professional relations department.
5. Collaborates with the Quality Program Manager to ensure Delta Dental of Arkansas meets quality metrics and performance standards for the Dental program.
6. Educates, administers, tracks, and provides data analysis for programs such as pay for performance, utilization management, quality of care, and clinical review.
7. Coordinates and monitors dashboard tools provided to dental offices and facilitate participation in the Provider Toolkit portal within the ETS claims system.
8. Assists in the development of written and electronic clinical and other informational material for use in education and outreach.
9. Ensures Delta Dental of Arkansas obtains NCQA accreditation for credentialing, including evaluation of NCQA requirements, development of written policies and procedures, creation of necessary work flows, education and training of workforce, and working and managing outside third parties involved in this effort. Will serve as project lead if NCQA accreditation is pursued.
10. Reviews certain claims to include attachments (e.g. radiographs, periodontal charting, photos, narratives, and patient chart notes/progress notes) and make a determination to approve, deny, disallow, or allow alternate treatment based upon guidelines of the group contract.
11. Keeps current on ADA CDT procedure codes, DeltaUSA processing policies, DDAR processing policies, policies of self-funded groups, and current dental techniques and procedures. Administers claim review utilizing the appropriate policies and procedures.
12. Investigates, makes determinations, performs or coordinates adjustments on difficult provider claim appeals, confers with treating dentists on questionable treatment cases when indicated, and documents results.
13. Renders prospective and post-service utilization review determinations and oversee the application of utilization review activities carried out by non-licensed personnel, including the application of pre-established decision criteria.
14. Provides dental expertise and/or interpretation of dental policies, procedures codes and processing guidelines to internal and external contacts.
15. Handles oversight and responsibility of the clinical aspects of the credentialing program.
16. Reviews consultant auditing results and recommends corrective action when needed.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
Requirements: Minimum Qualifications:
• Holds a current, unrestricted license to practice dentistry in Arkansas.
• Must have at least ten (10) years of relevant, post-graduate, direct patient care experience in the practice of dentistry.
• If a specialist, must be board certified.
• Must be qualified to render a clinical opinion about dental conditions, procedures, and treatment.
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