State Dental Director, Mississippi

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Our Mississippi 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 Mississippi. Our chosen candidate will effectively interact under Compliance’s leadership and the Quality division within the company’s Mississippi 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 Mississippi 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 …