Director, Tristate Quality Operations

Job Title:

Number of Positions:

Location:

Location Specifics:

Job Summary:

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community. 

Position Description:

Plans, organizes and directs the Quality Assurance and Performance Improvement program to ensure quality improvement goals and objectives are met through implementation, tracking and assessment of projects related to government program business in the Tristate region, including day-to-day management of client specific projects, personnel and administrative responsibilities.

Primary Job Responsibilities:

• Supervises, directs, develops, hires and evaluates staff activities to ensure operational effectiveness and continuous improvement of population health management programs, goals and services, including a team of care coordinators, data analysts, and other quality management staff.
• Oversees analysis of available data to identify patterns, trends, and opportunities for enrollee, provider, or stakeholder outreach to increase benefit awareness and meet utilization targets.
• Leads performance improvement projects (PIPs) designed to improve health plan administration, prioritizes quality improvement efforts, and allocates internal resources as required.
• Recommends and assists with implementation of short and long-term strategies, goals and objectives for member outreach, including text, email, social media, postal mail, newsletters, and other methodologies.
• Participates in the development and monitoring of the annual departmental budget, as well as tracking expenses to be identified and included on Dental Loss Ratio (DLR) and Quality Improvement Expense reporting.
• Identifies opportunities and develops and implements plans to improve dental health plan administration and the oral health status of assigned plan participants through analysis of performance measurement data, complaints, grievances and appeals, cross‐departmental observation of procedures and processes and consultation with plan participants, parents/guardians, providers, internal staff, external dental health plan administrators, community-based organizations and other key stakeholders.
• Participates in business and professional organizations to develop relationships and improve Delta Dental’s knowledge and expertise in support of programmatic growth and capabilities.
• Directs, develops, implements, oversees, and evaluates the Quality Assurance and Performance Improvement (QAPI) program, including the QAPI plan and the systems, policies, procedures, and guidelines for the identification, collection, and measurement of quality and utilization data.
• Oversees the provider pay for performance program and initiatives, in collaboration with the Chief Dental Officer and other internal departments, including actuarial, professional relations, network, and finance.
• Develops and creates oral health presentations appropriate to the defined audience in a variety of formats.
• Supports business development efforts, serving as the primary contact for QAPI related activities in RFP responses, health plan collaborative responses, and with external consulting firms.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements:

Position requires a bachelor’s degree in business administration, healthcare administration, or a related field, seven years of experience in a position requiring advanced knowledge of dental terminology, dental procedures, appropriate dental care, oral health education programs, and/or medical field expertise of the same nature, and five years of leadership experience. Master’s degree, project management experience, or clinical level of expertise is preferred. Experience with quality and performance improvement strategy and metrics, such as HEDIS, NCQA, or DQA, as well as health plan, dental plan or other type of payer or insurance is also preferred. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of dental terminology, dental procedure codes, appropriate dental care, and the claims adjudication process; care coordination planning, implementation, analysis and reporting skills; strong analytical skills; knowledge of word processing, spreadsheet, and database applications; strong verbal and written communication skills; the ability to represent and present on behalf of the organization, both internally and externally; the ability to work independently and as part of a team; the ability to manage multiple projects with competing deadlines; and the ability to resolve complex problems and use independent judgment.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.