Dental Operations Manager

Centene Corporation

3d•Hybrid

About The Position

The Dental Operations Manager is responsible for managing, directing and supporting the dental operations for our Medi-Cal, Healthy Families and Medicare members. The director is also responsible for ensuring compliance with our Department of Health Services (DHS) and Healthy Families MRMIB contracts. Monitors Health Net's performance under its dental services contracts with the State. Ensures compliance with all aspects of the contracts. Oversees Health Net's dental administration functions that are performed by the designated third party administrator. Monitors administrator’s performance against contract. Acts as point person for provider relations and inquiries. Maintains and expands provider network through contract negotiations and execution. Works closely with Dental Director to ensure that the dental care provided meets the standards for acceptable dental care. Performs utilization review by reviewing claims and encounter data. Develops and implements policies and procedures for the dental plan. Assists in grievance resolution related to quality of care under the dental plan. Actively participates in plan grievance procedures under the dental plan. Makes recommendations as needed to HN management on ways to improve/enhance dental operations.

Requirements

College degree in Business preferred.
Five to ten years managed care dental experience.
Prior experience with negotiating provider contracts preferred.
Candidate must live in CA.
Will require some travel.

Responsibilities

Managing, directing and supporting the dental operations for Medi-Cal, Healthy Families and Medicare members.
Ensuring compliance with Department of Health Services (DHS) and Healthy Families MRMIB contracts.
Monitoring Health Net's performance under its dental services contracts with the State.
Ensuring compliance with all aspects of the contracts.
Overseeing Health Net's dental administration functions performed by the designated third party administrator.
Monitoring administrator’s performance against contract.
Acting as point person for provider relations and inquiries.
Maintaining and expanding provider network through contract negotiations and execution.
Working closely with Dental Director to ensure that the dental care provided meets the standards for acceptable dental care.
Performing utilization review by reviewing claims and encounter data.
Developing and implementing policies and procedures for the dental plan.
Assisting in grievance resolution related to quality of care under the dental plan.
Actively participating in plan grievance procedures under the dental plan.
Making recommendations to HN management on ways to improve/enhance dental operations.