PCDH Coordinator

Delta Dental of Michigan•Nashville, TN

5d•Hybrid

About The Position

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 Oversees all aspects of Patient Centered Dental Home assignment, including system process updates, any provider requests or concerns related to member assignments or process, any member concerns, questions, or updates necessary, fulfilling reporting requirements, and communication to internal and external stakeholders. Ensures members are educated on dental wellness, including preventive care, comprehensive care, and acute care through collaboration with case managers and Managed Care Organization coordinators on overall outreach strategy.

Requirements

Position requires a bachelor's degree in healthcare administration, business administration, public health, dental hygiene, or a related field and three years of experience in patient care coordination in a healthcare environment or designing or administering a public health program or dental education program.
Will accept any suitable combination of education, training, or experience.
Position requires strong analytical, problem solving, communication, and organizational skills; the ability to manage multiple tasks, work collaboratively with various departments, and effectively communicate with patients and healthcare providers.
Must reside in Metropolitan Davidson County, Tennessee or a county contiguous to Metropolitan Davidson County, Tennessee.

Nice To Haves

Experience with word processing, spreadsheets, database applications, and the use of healthcare management software and tools is preferred.

Responsibilities

Supports key areas of the TennCare and Contractor’s Dental Home Strategy, monitoring utilization and prioritizing increased utilization of high-value preventative dental services, jointly designing the scope of responsibilities and high-value activities with TennCare.
Implements the overall Dental Home Strategy, including supporting both member and provider outreach, coaching, and education.
Collaborates with project management team on system updates, revisions, or additions to the Dental Home workflow in Roosevelt.
Maintains and updates the Patient Centered Dental Home sections of the provider manual, as well as references within the member handbook.
Monitors and analyzes reports regarding the Patient Centered Dental Home program.
Proactively identifies opportunities and barriers to patient dental utilization.
Ensures that members and their families receive preventive services from a trusted primary care dentist, which helps control oral diseases and reduces the need for restorative services.
Facilitates communication between members, dental providers, Managed Care Organizations and other healthcare professionals to ensure continuity of care.
Seeks input from others, listens effectively, and uses diplomacy, tact, and consensus to build relationships and gain trust, respect, and support with internal and external stakeholders.
Develops, recommends, implements, and enforces policies, procedures, guidelines, and standards of operations for the Dental Home Strategy.
Assist in periodic compliance efforts and ensure compliance with healthcare regulations and standards.
Develops ad hoc reporting for Dental Home strategy independently, or in collaboration with internal reporting teams, for internal and external use.
Directs tracking of provider terminations and reassigns members to another Dental Home, as necessary.
Reassigns members upon request from TennCare, providers, MCOs, or DDA, as well as at member request through automated systematic processes, or manually, as necessary.
Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.