Dental Director

Amerihealth Caritas•Washington, DC

1d•$167,600 - $277,300•Onsite

About The Position

The Dental Director oversees dental benefits for the District of Columbia, Delaware, and Marketplace Plans. The role develops and leads dental strategy to meet state requirements, incorporate oral health prevention and treatment into population health efforts, and support holistic, person-centered, integrated care. The Director ensures dental benefits comply with standards of dental care and oversees dental quality and access measures and utilization management so members receive timely, appropriate, and medically necessary care. The role collaborates with medical, behavioral health, pharmacy, population health, quality, network, compliance, vendor oversight, and state agency partners to improve oral health outcomes and member experience and to meet applicable requirements. The Director provides clinical expertise to internal teams and external partners, supports dental policies and workflows, participates in audits and regulatory and accreditation activities, and uses data and feedback to guide strategy and continuous improvement. This is an office-based role at 1201 Maine Ave SW in Washington, DC, Monday through Friday, 8:30 AM to 5:00 PM EST.

Requirements

Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM) degree from an accredited dental school.
At least 5 years of clinical dental experience.
Active and unencumbered license to practice dentistry in the District of Columbia.
Knowledge of Medicaid managed care, dental utilization management, medical necessity review, quality improvement, regulatory compliance, and standards of dental care.
Familiarity with NCQA, HEDIS, EPSDT, state Medicaid contract requirements, member appeals and grievances, and prior authorization processes.
Strong clinical judgment and knowledge of evidence-based dental standards of care.
Ability to interpret and apply Medicaid contractual, regulatory, accreditation, and compliance requirements.
Strong analytical skills to evaluate utilization trends, quality metrics, access data, and performance results.
Excellent verbal and written communication skills, including presenting clinical and operational information to executive, regulatory, provider, and cross-functional audiences.
Demonstrated ability to collaborate across medical, behavioral health, pharmacy, network, quality, compliance, operations, and vendor teams.
Ability to influence, lead, and drive improvement in a matrixed managed care environment.

Nice To Haves

Clinical dental experience involving Medicaid, managed care, public health, dental benefit administration, or care delivery for underserved populations.
Experience working with dental providers, provider networks, state agencies, vendors, or cross-functional health plan teams.
Experience in a Medicaid managed care organization, dental benefits administrator, public health program, or value-based care environment.
Experience leading dental quality improvement initiatives, provider education strategies, access improvement efforts, or vendor oversight activities.
Utilization management or dental claim/authorization review experience.

Responsibilities

Develop and lead dental strategy for the District of Columbia, Delaware, and Marketplace Plans to meet state requirements and integrate oral health prevention and treatment into population health and person-centered care.
Provide clinical oversight of dental benefits to ensure compliance with standards of dental care, contractual requirements, regulatory expectations, and accreditation standards.
Oversee dental quality and access measures and develop and monitor improvement strategies to close gaps and improve member outcomes.
Oversee utilization management of dental benefits to help ensure members receive timely, appropriate, and medically necessary dental care.
Collaborate with medical, behavioral health, pharmacy, population health, quality, network, compliance, vendor oversight, and state agency partners.
Partner with provider network, provider relations, and vendors to support dental provider recruitment, access expansion, provider education, and service delivery capacity.
Serve as a clinical dental subject matter expert for internal teams, external partners, providers, committees, audits, regulatory reviews, appeals, grievances, and quality improvement activities.
Support the development, implementation, and maintenance of dental policies, procedures, provider guidance, clinical criteria, and operational workflows.
Participate in audit readiness, regulatory reporting, accreditation activities, compliance reviews, and remediation efforts related to dental benefits and services.
Use data, quality indicators, provider feedback, member experience insights, and utilization trends to inform dental strategy, program design, and continuous improvement.
Promote preventive dental care, early intervention, member engagement, and oral health education strategies.