Missouri Dental Director, DentaQuest - Part-Time

Sun Life•Kansas City, MO

2d•$65,400 - $98,100•Hybrid

About The Position

Sun Life U.S. is seeking a part-time Dental Director for DentaQuest, a subsidiary managing dental and vision benefits for over 33 million Americans. This role acts as a clinical subject matter expert for internal entities and the state of Missouri, focusing on outcomes-based, cost-effective solutions. The position requires residing in Missouri and involves reviewing claims, evaluating appeals, counseling providers, identifying utilization patterns, and providing clinical support and feedback on policies. The role embraces a hybrid work model, balancing in-office collaboration with virtual flexibility.

Requirements

Graduate of an accredited Dental School (D.D.S. or D.M.D)
Maintain an unrestricted dental license in the state of Missouri
Physically reside in the state of Missouri
At least 5 years of clinical experience preferred
Efficient PC skills
Ability to use analytical/presentation tools such as Excel and PowerPoint.
Organizational and time management skills
Ability to work with a team and independently to complete assigned tasks without supervision
Ability to make independent determinations on all types of dental claims
Excellent written and verbal communication skills
Ability to distinguish between multiple market benefits
Ability to prioritize and organize multiple tasks
Ability to remain organized with multiple interruptions
Networking and Negotiation skills required
Ability to travel as needed
Required to attend additional training as requested/deemed necessary

Nice To Haves

Knowledge of general dentistry
Public health or pediatric experience a plus

Responsibilities

Act as a clinical subject matter expert for internal entities and the state of Missouri.
Review claims based on medical necessity, in accordance with market contracts.
Evaluate appeals.
Counsel providers.
Identify providers with aberrant utilization patterns.
Provide clinical support for provider outreach.
Provide feedback on clinical policies.
Facilitate educational trainings for dental providers.
Represent DentaQuest professionally when interacting with clients, management, employees, the provider community, dental associates, and other key stakeholders.
Adhere to all DentaQuest policies, processes, and procedures.
Identify and recommend process and productivity improvement opportunities.
Establish and maintain an understanding of dental program administration, including benefit and authorization requirements, claims payment and denial processes, and ASO and Risk relationships.
Develop a strong knowledge base of state and federal dental regulations.
Proactively alert DentaQuest staff of potential state regulatory changes impacting dental benefits/administration.
Act as a DentaQuest liaison to the provider community, offering educational sessions.
Proactively identify and participate in activities, programs, and speaking engagements associated with Medicaid and Medicare Dental Programs.
Identify and recommend regional community related activities and events (e.g., Health Fairs, Dental Screenings, Back to School Programs) for DentaQuest participation.
Establish and maintain an understanding of DentaQuest’s Oral Health Wellness and Outreach Programs.
Review dental cases and represent DentaQuest at fair hearings, as needed or directed.
Establish and maintain strategic relationships with regional dental associations and key stakeholders for new business development and maintenance.
Recruit qualified providers for DentaQuest networks as needed or directed.
Perform other duties as assigned.

Benefits

Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive and collaborative work environment that supports career growth