Dental Director - Florida

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Our Florida State Dental Director will be a leadership role in managing our Dental Service Program relationships at the state level, under the direction of the VP of Dental Services. This role includes supporting Dental Program Management efforts to build and maintain network relationships in Florida. Our chosen candidate will effectively interact under Compliance’s leadership and the Quality division within the company’s Florida sponsored Medicaid dental programs, along with other government plans and Commercial Insurance (should Avēsis engage in these programs). Strong emphasis on regular communication with participating network dentists, Provider Relations, Utilization Management and Account Management.

Essential Job Functions:

Clinical Review and Utilization Management

• Assist in coordination of assignment of Dental Consultants for Florida business and assure they complete all necessary claim reviews and authorizations on a timely basis.
• Work with the Associate National Dental Director, Utilization Management to monitor queues and outstanding Pre/Post Authorizations/Appeals.
• Review of Quality Assurance Policies and Procedures, guidelines, and clinical protocols relative to the dental programs, at least annually. Coordinate with UM staff to establish proper referral processes.
• Understand and lead efforts to enforce and review Corrective Action Plans (CAPs) for network dentists imposed by FWA.
• Understand and lead efforts to respond to CAPs presented to Avēsis from clients.
• Be available for review of claims appeals escalated through UM Department or Complaints and Appeals Department. Be available for hearings when necessary.
• Hold peer to peer discussions with participating providers to review quality of care issues, practice deficiencies, appeals or other matters relative to the Dental programs as recommended by Compliance and/or Quality Department.
• Discussion around score cards as it relates to State providers and the interaction with the Quality Department.

Oversight of Committees and Protocols

• Chair of the state Dental Advisory Board.
• Engage and maintain proper representation of the in state Dental Advisory Board based on the respective state’s requirement (provided by Compliance).
• Active participation and regular attendance on the Credentialing Committee, Utilization Review Committee, and State Quality Assurance Committee.
• Assist with review of Policies and Procedures, guidelines, and clinical protocols relative to the Dental programs, at least annually.

Interaction with Avēsis Provider Relations Field Staff

• Conduct office audits with Avēsis Provider Services Field Representatives, as needed.
• Available to coordinate fraud and abuse investigations with the FWA department.
• Available to coordinate with client FWA staff to provide proper reporting on investigations as directed by FWA/Compliance as it relates to CAPs.
• Assistance with decisions regarding referrals and to whom referrals should be made.
• Working with PR and providers in making single case agreements in maintaining continuity of care for members as directed by VP of Dental Services.
• Active participation and regular attendance on quarterly meetings TAC (Technical Advisory Committee)/JOC (Joint Operation Committee) with MCO/PR/AM.

Market and Clinical strategy development

• Facilitate/engagement with State/Local agencies/institutions with New/Upcoming initiatives.
• Working with in-state dental associations in understanding the landscape and evaluating gaps in access of care for members.
• Working with in-state dental schools for potential partnerships on upcoming interventions.
• Working with in-state dental schools in discussion of policies that can be edited as proposed by VP of Dental services for the dental schools to partner with us in acceptance of standards.
• Working with Avēsis Innovation team in developing/discussing/identifying potential vendor/partners in States to assist Avēsis in furthering innovation development.

Management of Dental Consultants

• Holding IRR (Inter Rater Reliability) testing to calibrate with all the Dental Consultants, associated with States to stay compliant with current contracts as it relates to frequency that meetings are held and outcomes of testing.
• Hold monthly meetings in discussion of pain points in current process to bring to National Director Advisory Committee and VP of Dental Services for review.
• Delegate Peer-to-Peer and Appeals to appropriate consultant as needed for compliance.

Other

• Clinical oversight for all aspects of Florida State dental programs including plan design, review of new methodologies, appropriateness of care, etc.
• Discussion, if necessary, with CMO medical directors.
• Other duties as assigned.

Requirements:

• Must reside in the State of Florida for consideration, per State Contract.
• Dental Degree from an U.S. accredited Dental School.
• DDS or DMD; holder of an active, unrestricted Florida dental license.
• Minimum of seven (7) years’ experience as a practicing dentist or dental specialist.

Skills:

• Clear communication skills.
• Effective project management skills.
• Strong presentation skills.
• Word processing: Ability to learn claim processing systems; Familiarity with Microsoft Suite (Excel, Outlook, Word).

Knowledge:

• Experience in delivery of dental care; knowledge of government and commercial plan designs and administration a plus. The director should be able to render consistent opinions on emerging dental trends, utilization review, dental plan coverage, network management, claims policy and standards of care.

Other:

• Completion of credentialing process following NCQA guidelines.
• Travel: Occasional.

FLSA Status:  Salary/Exempt
National Salary Range:  $90,220 - $120,290

How to stay safe:
Avesis is aware of fraudulent activity by individuals falsely representing themselves as Avesis recruiters. In some instances, these individuals may even contact applicants with a job offer letter, ask applicants to make purchases (i.e., a laptop or gift cards) from a designated vendor, have applicants fill out W-2 forms, or ask that applicants ship or send packages of goods to the company.
Avesis would never make such requests to applicants at any time throughout our job application process. We also would never ask applicants for personal information, such as passport numbers, bank account numbers, or social security numbers, during process. Our recruitment process takes place by phone and via trusted business communication platform (i.e., Zoom, Webex, Microsoft Teams, etc.). Any emails from Avesis recruiters will come from a verified email address ending in @Avesis.com.

We urge all applicants to exercise caution. If something feels off about your interactions, we encourage you to suspend or cease communications. If you are unsure of the legitimacy of a communication you have received, please reach out to ITsupport@Avesis.com.

To learn more about protecting yourself from fraudulent activity, please refer to this article link (https://consumer.ftc.gov/articles/how-avoid-scam).  If you believe you were a victim of fraudulent activity, please contact your local authorities or file a complaint (Link: https://reportfraud.ftc.gov/#/) with the Federal Trade Commission. Avesis is not responsible for any claims, losses, damages, or expenses resulting from unaffiliated individuals of the company or their fraudulent activity.

We Offer

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity

At Avēsis, We See You.  We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.  At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.  We focus on recruiting, training and retaining those individuals that share similar goals.  Come Dare to be Different at Avēsis, where We See You!

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