Amerihealth Caritas
From Amerihealth Caritas's careers page
Status: listed on the employer's own careers page when we last checked (daily). Confirm on their site before applying.
We’re looking for the next generation of health care leaders.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
The Dental Director will have oversight of the District of Columbia, Delaware, and Marketplace Plans. In this role, you will develop and lead the dental strategy to meet state requirements, incorporating oral health prevention and treatment into the Plan’s population health efforts and the delivery of holistic, person-centered, integrated care. Ensures dental benefit operates in compliance with standards of dental care. Oversee performance on dental measures. Oversee utilization management of dental benefits to ensure members receive timely, appropriate, and medically necessary dental care.
Works collaboratively with medical, behavioral health, pharmacy, population health, quality, network, compliance, vendor oversight, and state agency partners to advance oral health outcomes, improve member experience, and ensure compliance with state, federal, contractual, and accreditation requirements.
Provide clinical oversight of dental benefits to ensure services are delivered in compliance with applicable standards of dental care, contractual requirements, regulatory expectations, and accreditation standards.
Oversee performance on dental quality and access measures, including development and monitoring of improvement strategies to close gaps and improve member outcomes.
Partner with provider network, provider relations, and vendor partners 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 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 that improve long-term health outcomes.
Work Arrangement
Must work in our office located at 1201 Maine Ave SW in DC
Monday through Friday, 8:30 AM EST to 5:00 PM EST
Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DDM) degree from an accredited dental school
Minimum of 5 years of clinical dental experience, preferably including Medicaid, managed care, public health, dental benefit administration or care delivery for underserved population
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 desired
Licensure
Must possess an 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 with the ability to evaluate utilization trends, quality metrics, access data, and performance results
Excellent verbal and written communication skills, including the ability to present 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
The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the DC area.
Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.
AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.
The targeted hiring range for this role is expected to be between $167,600.00 and $277,300.00.
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