At Delta Dental, our strategy is only as strong as the people who execute it! We are hiring individuals that are not just right for today but also for our future. We have built a foundation of high-trust by treating all people with dignity, making and keeping commitments, and consistently striving to do the right thing. Our leaders optimistically share future possibilities to inspire and motivate others toward their full potential. We expect our employees to find ways to embrace positive change, be curious and challenge the status quo, and provide solutions to unmet problems. Joining Delta Dental means joining a culture focused on fostering development, building genuine connections, recognizing each other’s strengths and sharing in successes.
The Surveillance and Utilization Review (S/URS) Senior Manager oversees efforts to detect and prevent fraudulent activities by providers and members, and efforts to monitor and improve the quality of dental care provided to Medi-Cal Dental members. The S/URS Senior Manager also ensures that Department directives and contractual requirements are fulfilled and measures performance, evaluates processes and makes recommendations for improvement. The Senior Manager reports to and supports the Dental Policy Director.
How you will make an impact:
- Acts as the principal officer with responsibility for Delta Dental’s efforts to detect and prevent fraudulent activities among the provider and beneficiary communities.
- Oversees all S/URS functions and responsibilities, including but not limited to participating in the development of organizational goals, applying dental policies, standards, rules and regulations of the Medi-Cal Dental program in adjudication rulings.
- Provides a ‘professional dental face’ to the provider community, including but not limited to interpreting program regulations for dental services to dental societies and other provider groups
- Interacts with designated representatives from the Department of Health Care Services (DHCS or ‘the Department’) and other State Agencies and the Dental Board of California.
- Advises the Contractor Representative in dental matters related to S/URS operations
- Serves as a liaison between Delta Dental, the Department, federal representatives and major dental care organizations and works with DHCS to resolve problems concerning the Medi-Cal Dental S/URS program and its providers and/or members.
- Serves as a single point of contact with the Department on S/URS activities
- Develops processing policies that adhere to regulations and State contract terms and communicates policy decisions to department staff, working with them to comply with these standard operating policies and procedures and to achieve goals.
- Chairs the Case Review Committee
- Serves as a member of the QMI Committee
- Serves as a member of the UM Committee
- Reviews cases of suspected fraud, abuse and poor quality of care and determines corrective action, suspension or termination of provider agreements
- Serves as an expert witness, providing testimony at hearings, court proceedings and trials related to all aspects of Medi-Cal Administrative Services Organization (ASO) program operations
- Coordinates with the Directors of Operations and Customer Service to identify and evaluate potential cases involving quality of care, provider utilization and/or abuse issues as part of the S/URS quality review program
- Directs staff including determining staffing needs, setting goals, interviewing, selecting, coaching and evaluating the performance of all direct reports.
What we look for:
- Licensed dentist in the State of California, the license of which shall be current and in good standing at the time of hire and remain so during the entirety of their employment.
- Shall have attained higher education level degree(s) from an accredited four-year university/college and shall have completed graduate level coursework and dental requirements.
- Obtained professional credentials and/or license(s) in disciplines relative to the position that are valid in the State of California. Credentials and/or licenses to practice in their professional field must be current at the time of hire and remain current during the entirety of their employment.
- Minimum of 2 years of supervisory experience.
- Minimum of ten years of clinical experience.
- Minimum of eight years’ experience working for a government or private sector healthcare payer similar in size and scope to the California Medi-Cal Dental program, at least five years of which must have been in a managing role.
- Excellent verbal, written and presentation communication skills.
- Two years of claims processing and/or quality assessment experience.
- Extensive knowledge of health care industry and dental procedures, codes and nomenclature.
- Knowledge of Medi-Cal Dental policies and procedures.
- Excellent organizational, time and project management skills with multi-tasking abilities.
- Strong analytical skills to identify and evaluate business solutions.
- Strong management skills to manage department activities effectively.
- Experience in Microsoft Office Suite: Outlook, Word and Excel.
Benefits and perks:
- 12 days starting vacation plus 12 holidays and your birthday off!
- Multiple medical insurance options: 100% paid or low cost premiums
- 100% paid dental insurance
- 100% paid vision insurance
- Onsite gym and/or gym discount and fitness incentive
- Culture of learning: substantial tuition reimbursement to improve your skills
- Career growth: we love promoting from within
- Strong commitment to work/life balance
- Technology allowance
- Social responsibility and volunteer opportunities
At Delta Dental we:
Promote accountability, integrity and collaboration: Our employees are collaborative, self-aware, and ethical. It is our expectation to do the right thing and follow through on commitments.
Foster professional development: Our employees take ownership of developing themselves and others through coaching, mentoring and providing/being open to constructive feedback and identifying learning opportunities.
Value customers and cultivate positive experiences: Our employees take time to build rapport with customers, while anticipating and exceeding their needs to ensure positive outcomes.
If you think this sounds like you, let’s chat. We would love to tell you more!
ABOUT Delta Dental
Delta Dental covers more Americans than any other dental benefits provider. As an employee you’ll take part in our mission to become the trusted health partner by collaborating with our communities and employees to reimagine and deliver new possibilities in an ever-changing environment. Our Enterprise Strategy focuses on pillars of Growth and Diversification, supported by the platforms of Culture and People, Process and Technology. Our employees take pride working for a purpose-driven organization and live our values of Trust, Service, Excellence and Innovation.
We are part of the Delta Dental Plans Association, a network of companies that provides dental coverage to 74 million people in the U.S. Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania and Delta Dental Insurance Company, together with our affiliate companies, form one of the nation’s largest dental benefits delivery systems, covering 33 million enrollees. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies throughout the country.
Delta Dental provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other classification protected by federal or state law. In addition to federal law requirements, Delta Dental complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
- Medical, Dental and Vision
- Vacation/paid time off
- Professional Development
- Paid Holidays
- Life Insurance