The Provider Network Cost and Quality Manager (Internally this position is title the Dental Home Manager) will have a special focus on managing the dental home program. This includes internal and external training and communications, member assignments, outreach, provider payment, monitoring systems and reporting needed for effective management of the dental home program, including financial effectiveness.
JOB DUTIES AND RESPONSIBILITIES:
- Manage optimization of dental home partnerships including program implementation, promotion of dental home management principles and process improvement.
- Manage, analyze, select and maintain network of participating providers.
- Work with underwriting to achieve loss ratio goals through effective member assignment, monitoring and management of services rendered and addressing non performing providers.
- Manage financial results of the dental home program including loss ratio and administrative expenses.
- Design reports to effectively manage member assignment, performance of provider offices and achieving access goals.
- Develop and implement innovative approaches to improve the quality of information exchanged between DentaQuest and dental offices.
- Assist with member management, ensuring the right member gets the right treatment and the right place and right time.
- Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations.
- Creation of dental home materials including marketing, training, reports, policies and procedures.
- Assist with designing the web portal as an effective method of educating providers and posting marketing documents and reports for providers.
- Educate providers on the dental home concept.
- Educate internal team members and external stakeholders and clients on the dental home concept.
- Assist with collaborating with and educating physicians and their role in working with dentists and DentaQuest.
- Adhere to DentaQuest business processes.
- Other duties as assigned.
- Bachelor’s degree or equivalent experience.
- Dental or medical insurance knowledge with 7+ years of experience.
- Knowledge of dental home, medical home, care management or case management.
- Knowledge of regulatory and reimbursement strategies.
- Excellent analytical skills and ability to understand and interpret complex data/reports.
- Financial acumen and ability to understand financial statements, loss ratio and provider reimbursement.
- Excellent verbal, presentation and written communication skills.