Dir Med Clin Ops; VP of Dental Operations-Telecommute - Full-time / Part-time

The Vice President of Dental Operations is a key member of the UnitedHealthcare Clinical Services Team with direct dental utilization management accountability for a national dental organization serving over 6 million members.  Products and networks include DPPO, DHMO, D-INO, Discount, and Medicaid Dental plans underwritten through a variety of integrated and dental-focused legal entities.

This individual will serve as single point of contact for the UnitedHealthcare Clinical Services dental program to UHG, UnitedHealthcare and the Specialty Benefits Organization.   Additionally, this leader will understand how to drive complex business processes throughout a matrix organization. Results are critical to this leader's success, as is a personal alignment with UHC's core belief that an organization can manage cost and deliver quality and value to its customers.

Primary Responsibilities:

• Responsible for the oversight of system wide improvement initiatives, with improved quality outcomes and improved efficiency and enhanced value


• Assessment of Dental team structure, capabilities and applicability to functional roles


• Advance the integration of the Dental Team into UnitedHealthcare Clinical Services


• Development, approval, and implementation of a comprehensive organizational strategy for Dental UM Team


• Development of appropriate business metrics to optimize decisions, clinical outcomes and productivity


• Continual coordination of multiple projects and priorities while keeping internal and external stakeholders informed


• Responsible for achieving an affordability agenda


• Ensuring quality assurance practices are implemented and upheld; monitor and report on quality in addition to maintaining industry standards


• Partnering with key operations and support teams and leaders to define program requirements, expected benefits, and associated service level agreements are met


• Develop and execute proactive analytics that drive an effective UM program


• Monitor and maintain appropriate clinical and non-clinical claim system edits


• Identify and study general and specific utilization trends, and adjust UR program to target services and providers for prospective global claim review


• Develop and maintain a UM program strategy to profile provider utilization, including focused provider review, including UM vendors and consultants


• Research targeted provider utilization based on utilization profile, counsel on their patterns, issue provider report cards, recover funds as appropriate, and refer suspected fraud and abuse for action


• Maintenance of Quality Management Program, Quality Improvement Program


• Determination of grievance and appeals and dental process oversight


• Coordinate and monitor provider and site audits for managed care and Medicaid networks as indicated by local regulatory requirements


• Engaging in RFP creation and evaluation and development, negotiation, and monitoring of SOWs associated with external solution vendors


• Development and  maintenance of policies and procedures 


• Monitoring and maintenance of clinical review guidelines for global and focused review


• Responsibility for regulatory compliance on all dental products and functions


• Liaison with Legal and Product Development on managed care contract, compliance, and regulatory filings


• Create and implement a progressive approach to the UM function, including appropriate staffing and vendor selection


• Recruiting, talent development, and ongoing engagement of professional staff

Required Qualifications: 

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  Bachelor's Degree in Healthcare or related equivalent



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  7-10 years managing a dental program or equivalent and clinical and non clinical staff related to the quality and care management activities



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  Management and implementation of UM on a national level



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  Experience with Claim Reviews including Fraud and Abuse



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  Experience in Quality Management



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  Experience with Client and regulatory audits



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  Excellent communication, collaboration, team building and relationship management skills



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  Successful in obtaining results in a large corporate, matrixed environment



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  Capable of gaining support for initiatives through influence and use of business rationale



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  Proven ability to make and implement tough decisions

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.