This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2343654 Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person\'s talents and strengths.

On a part-time basis, provide expertise to improve oral health care services for PacificSource members through internal and external-facing activities. Employ clinical knowledge to support oral health utilization management, as well as clinical integration, health promotion, disease management, pharmacy review, dental case review, grievance and appeals, quality programs, and cost of care management. Actively engage with the provider community across PacificSource\'s service areas in support of strategic, clinical, and operational goals. Coordinate external-facing operations of appropriate departments and interface with appropriate regulatory agencies to influence, understand, and implement policies and procedures. Work in collaboration with regionally-based PacificSource staff as well as health care leaders to meet or exceed quality standards and to coordinate and facilitate work across lines of business and organizations in order to optimize operational and community effectiveness.

Essential Responsibilities:

• Coordinates the integration of PacificSource\'s dental programs and services with other programs.
• Responsible for personal as well as departmental full compliance with all applicable federal, state, local and center rules, regulations, protocols and procedures governing the practice of dentistry and the clinical provision of dental care.
• Provide advice and counsel to all personnel on matters related to care, member grievances and related issues. Participate as a subject matter expert in Cost of Care working groups, to include anticipation of trends impacting global budget, and proactively addressing those trends in line with Triple Aim goals.
• Lead and direct the dental program\'s quality improvement initiatives. Ensure metrics for outcomes are consistently reviewed, and that the organization is provided clear guidance and direction affecting ongoing improvements in the quality of care.
• Develops, coordinates, disseminates and enforces dental polices. Educates staff on rationale and need for adherence to dental policies including; Quality Improvement Program, National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set, Consumer Assessment of Healthcare Providers and Systems and HIPAA regulations.
• Manage all relationships with regulatory agencies, accreditation entities, network providers, and related concerns.
• Efficiently serve as a liaison with the local dental community and will review all dental provider contracts to provide professional dental advice to the Chief Medical Officer.
• Ensure the organization maintains a strong provider network of dental offices, dentists, hospitals, physicians, and ancillary providers able to meet the medical and dental care needs of members by partnering with credentialing team.
• Participates in all initiatives and concerns involving member safety, quality, infect on control, risk management and member service, especially those related to provider issues.
• Manage and ensure favorable relationships, as a representative of PacificSource, with local and state health departments, and local and regional provider community.
• Assist with reviewing pre-authorizations, claims, and other cases involving service requests for coverage. Assist with reviews and managing appeals, and lend expertise to the preparation of cases for further external review.
• Monitors and administers the annual budget; forecasts additional funds needed for staffing, equipment, materials, and supplies; monitors and approves expenditures; implements adjustments as necessary.

Supporting Responsibilities:

• Perform other accounting duties as assigned.
• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

Work Experience: Four years of hands-on dentistry experience and up-to-date knowledge of regulations, methods, trends and equipment required. Experience as a Dental Director role with a health insurance plan strongly preferred. Experience in an integrated healthcare system a plus.

Education, Certificates,