Dental Director, Health Plan
|Category:||Life Sciences/Healthcare : Hospital/Health Systems|
Position Dental Director, Health Plan
Company Molina Healthcare
Location Louisville, KY
Reporting Relationship Chief Medical Officer
Molina Healthcare, Inc., (NYSE: MOH) a FORTUNE 500 company, recently announced that Kentucky health plan subsidiary has been selected as an awardee by the Kentucky Cabinet for Health and Family Services (CHFS), Department for Medicaid Services (DMS). The new contact for Molina’s Kentucky health plan is expected to begin on January 1, 2021 and is one of five managed care organizations selected to offer health care coverage to approximately 1.4 million Medicaid beneficiaries through the Commonwealth of Kentucky’s TANF, CHIP and ABD programs.
Korn Ferry, in partnership with Molina seeks leaders passionate about transforming healthcare capable of playing a developmental role establishing Molina’s footprint in a strategic new market and carrying out their mission to improve the health and well-being of all their members. As a key senior hire in a new operation, you will play a foundational role on the Kentucky Health Plan team and have an opportunity to develop critical functions in state health plan operations, from early start=up to operating-at-scale.
Molina has a long history of providing government-funded, quality care to the most vulnerable populations and actively contributing to the communities it serves. Molina’s planned investments are expected to bring over 1,100 jobs to Kentucky and stimulate local development in the city of Louisville. Molina will be investing additional capital in the community by setting up the Molina Community Innovation Fund, which will provide $2/5 million over four years to address the needs of Kentucky’s Medicaid populations. This investment will build upon the contributions Molina has already made to community organizations in the state, including Louisville Urban League, Home of the Innocents, Family Scholar House, Dare to Care, Boys and Girls Club, and others.
MOLINA HEALTHCARE – BACKGROUND AND CULTURE
Molina provides managed health care services under the Medicaid and Medicare programs and through the state insurance marketplaces. Through its locally operated health plans, Molina Healthcare currently serves approximately 4.1 million members.
Molina’s businesses include:
Molina Health Plans
Medicaid Molina Healthcare contracts with state governments and serves as a health plan, providing a wide range of quality health care services to families and individuals who qualify for government-sponsored programs, including Medicaid and the State Children's Health Insurance Program (SCHIP). Molina Healthcare offers Medicaid plans in California, Florida, Illinois, Kentucky, Michigan, Mississippi, New Mexico, New York, Ohio, Puerto Rico, South Carolina, Texas, Utah, Washington, and Wisconsin.
Molina Healthcare offers Medicare Advantage plans designed to meet the needs of individuals with Medicare or both Medicaid and Medicare coverage. Molina Medicare plans offer comprehensive, quality benefits and programs including access to a large selection of doctors, hospitals, and other health care providers at little or no out-of-pocket cost.
Integrated Medicaid/Medicare (Duals)
Molina Healthcare has been selected for several duals demonstration projects as part of a member-centered health care approach for people who are eligible for both Medicaid and Medicare. Molina has already been working with these members through our Medicaid and Medicare health plans for many years, and this experience will help us provide these members with high quality care that meets their unique needs.
Molina Healthcare offers Marketplace (known as Exchange in some states) plans in many of the states where we offer Medicaid health plans. Our plans allow our Medicaid members to stay with their providers as they transition between Medicaid and the Marketplace. Additionally, they remove financial barriers to quality care and keep members’ out-of-pocket expenses to a minimum.
Generally, the occupational knowledge and specific technical and professional skills and abilities required to perform the essential duties of this job:
• Provides dental oversight in appropriateness and medical necessity of dental care services provided to Plan members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards.
• Serves as a resource for all clinical interpretation and analysis and oversees all aspects of the company’s utilization review and management activities related to dental care. Providers oversight of dental quality programs (HEDIS and P4P).
• Develops and implements clinical utilization processes and algorithms utilized in the authorization process; statistical methodology for use in utilization management and provider profiling analytics; dental policies and procedure; and Quality Improvement activities.
• Partners with Provider Contracts to secure and maintain a network of dental consultants.
• Educates and interacts with network and group providers regarding utilization practices, guideline usage, and effective patient management. Provides clinical representation for company presentations in partnership with provider relations.
• Provides guidance to staff regarding appeals, grievances, and member/provider complaints.
• Provides analytics and interpretation of dental benefit plan structures.
• Maintains accountability for consumer/member related decisions for self and network of dental consultants.
• Ensures that the dental care provided meets the standards for acceptable dental care and that dental protocols and rules of conduct for plan personnel are followed.
• Participates in professional and community activities to provide input and become knowledgeable regarding regulatory, professionally, and community standards and issues.
Successful candidates will have at least seven years of clinical dental practice experience and three to five years of experience as a Medical Director overseeing Utilization/Quality program management for a managed care organization. Candidates will also have experience working with state and federal regulatory bodies and developing and administering successful quality programs. S/He will have demonstrated excellence in verbal and written communication skills and an outstanding reputation with providers.
• Doctorate Degree in Dentistry (DMD or DDS)
• Board certified or board eligible (preferred)
Current, active and unrestricted Dental License with the authority to complete job responsibilities in applicable location to meet scope of work.
• 7+ years in clinical dental practice
• 3 - 5 years in health plan, insurance, or benefits administration setting
• Minimum 2 years’ experience with HMO/Managed Care
• Current clinical knowledge
• Knowledge of applicable state, federal and third-party regulations
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen
• Peer Review, dental policy/procedure development, provider contracting experience.
• Knowledge of NCQA, HEDIS, Medicare, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management
Required License, Certification, Association
• Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.