Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care!

PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion:  PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

On a part-time basis, provide expertise to improve oral health care services for PacificSource members through internal and external-facing activities. Employ clinical knowledge to support oral health utilization management, as well as clinical integration, health promotion, disease management, pharmacy review, dental case review, grievance and appeals, quality programs, and cost of care management. Actively engage with the provider community across PacificSource’s service areas in support of strategic, clinical, and operational goals. Coordinate external-facing operations of appropriate departments and interface with appropriate regulatory agencies to influence, understand, and implement policies and procedures. Work in collaboration with regionally-based PacificSource staff as well as health care leaders to meet or exceed quality standards and to coordinate and facilitate work across lines of business and organizations in order to optimize operational and community effectiveness.

Essential Responsibilities:

Coordinates the integration of PacificSource’s dental programs and services with other programs.

Responsible for personal as well as departmental full compliance with all applicable federal, state, local and center rules, regulations, protocols and procedures governing the practice of dentistry and the clinical provision of dental care.

Provide advice and counsel to all personnel on matters related to care, member grievances and related issues. Participate as a subject matter expert in Cost of Care working groups, to include anticipation of trends impacting global budget, and proactively addressing those trends in line with Triple Aim goals.

Lead and direct the dental program’s quality improvement initiatives. Ensure metrics for outcomes are consistently reviewed, and that the organization is provided clear guidance and direction affecting ongoing improvements in the quality of care.

Develops, coordinates, disseminates and enforces dental polices. Educates staff on rationale and need for adherence to dental policies including; Quality Improvement Program, National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set, Consumer Assessment of Healthcare Providers and Systems and HIPAA regulations.

Manage all relationships with regulatory agencies, accreditation entities, network providers, and related concerns.

Efficiently serve as a liaison with the local dental community and will review all dental provider contracts to provide professional dental advice to the Chief Medical Officer.

Ensure the organization maintains a strong provider network of dental offices, dentists, hospitals, physicians, and ancillary providers able to meet the medical and dental care needs of members by partnering with credentialing team.

Participates in all initiatives and concerns involving member safety, quality, infection control, risk management and member service, especially those related to provider issues.

Manage and ensure favorable relationships, as a representative of PacificSource, with local and state health departments, and local and regional provider community.

Assist with reviewing pre-authorizations, claims, and other cases involving service requests for coverage. Assist with reviews and managing appeals, and lend expertise to the preparation of cases for further external review.

Monitors and administers the annual budget; forecasts additional funds needed for staffing, equipment, materials, and supplies; monitors and approves expenditures; implements adjustments as necessary.

Supporting Responsibilities:

Perform other accounting duties as assigned.

Meet department and company performance and attendance expectations.

Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.

Work Experience: Four years of hands-on dentistry experience and up-to-date knowledge of regulations, methods, trends and equipment required. Experience as a Dental Director role with a health insurance plan strongly preferred. Experience in an integrated healthcare system a plus.

Education, Certificates, Licenses: Unrestricted license to practice dentistry in Oregon (DDS or DMD) with the ability to get licensed in Montana, Idaho, and Washington required, along with professional dental association memberships, DEA and State Board of Pharmacy licensing. Must have and maintain BLS and ACLS Certification.

Knowledge: Comprehensive knowledge of business principles and techniques of administration, organization, and management to include an in-depth understanding of the key business issues that exist in the healthcare industry. These include, but are not limited to quality improvement including, Lean methodology, healthcare economics, personnel administration, financial and cost analysis, trends in the healthcare industry. Excellent understanding of all areas of oral health conditions, treatment, and care. Excellent understanding of the insurance industry and risk factors and how they relate to the PacificSource organization. Remain current in the dental field. Basic computer skills required. In-depth knowledge of local clinical communities, along with in-depth knowledge of Oregon Health Plan preferred. Ability to read and comprehend Spanish a plus.

Competencies:

Authenticity

Building Organizational Talent

Coaching and Developing Others

Compelling Communication

Customer Focus

Empowerment/Delegation

Emotional Intelligence

Leading Change

Managing Conflict

Operational Decision Making

Passion for Results

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 30% of the time.

Skills:

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

We are committed to doing the right thing.We are one team working toward a common goal.We are each responsible for customer service.We practice open communication at all levels of the company to foster individual, team and company growth.We actively participate in efforts to improve our many communities-internally and externally.We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.