Dental Program Manager, Hybrid - Commonwealth Care Alliance - Boston, MA

Permanent Dental Receptionist / Front Desk Job

Boston, MA

Job Description

CCA-Ancillary Programs

Operational Excellence:

Efficiently manage day-to-day operations of dental program within the healthplan
Ensure compliance with regulatory requirements and industry standards.
Oversee claims processing, provider relations and member inquires related to dental benefits.

Vendor Oversight:

Collaborate with contracted vendors to ensure smooth execution of program services.
Monitor vendor performance, adherence to contract terms, and service level agreements.
Establish and maintain strong working relationships with vendors through regular communication and meetings.
Address any vendor-related concerns promptly and ensure compliance with program standards.


Issue Resolution:

Act as the point of contact for escalated inquiries, issues, and escalations.
Collaborate with cross-functional teams to address and resolve complex member issues.
Analyze root causes of member complaints and work on preventive solutions.
Ensure compliance with regulatory guidelines while resolving member issues.

Data Analysis and Reporting:

Analyze program data to identify trends, patterns, and areas for improvement.
Prepare regular reports on program performance, member feedback, and vendor compliance.
Make recommendations based on data analysis to enhance program effectiveness.

Program & Process Improvement:

Develop and implement strategic plans for the enhancement and expansion of dental programs.
Stay informed about industry trends, emerging technologies and best practices.
Collaborate with cross-functional teams to identify opportunities for program growth & improvement.
Continuously assess program operations and identify opportunities for process optimization.

Regulatory Compliance:

Stay informed about relevant Medicare regulations, guidelines, and updates.
Ensure the program operates in accordance with all regulatory requirements.

Collobartion:

Build and maintain strong relationships with dental providers, ensuring network adequacy and quality.
Collaborate with internal teams to integrate dental benefits seamlessly into overall Healthplan offerings.
Act as a liaison between CCA and external stakeholders, fostering positive relationships.


Standard Office Conditions

Required Education:

Bachelor’s degree in a related field (healthcare management, business administration, etc.) or equivalent experience.


Required Licensing:

N/A

Required Experience:


Requires 3-5 years of experience in dental program manahement including third party administration, healthplan or managed care environment,
Must be proficient at oversight and management of programs and/or vendros with demonstrated experience occurred within health plan, benefit administrators, consulting, business/strategic planning, and/or project management.
Some experience with influencing a diverse group of stakeholders.
Experience in third party vendor management, contract negotiation, and issue resolution.
Proficient in using office software (e.g., Microsoft Office, Excel).
Preferred Experience:

Familiarity with Medicare/ Medicaid regulations and guidelines is preferred.
Familiarity with dental quality of care guidelines and CDT coding.

Required Knowledge, Skills & Abilities:

Strong analytical skills with the ability to interpret program and vendor performance data and make recommendations.
Excellent interpersonal and communication skills.
Detail-oriented and able to multitask effectively.
Problem-solving mindset and ability to work well under pressure.
ENGLISH

Member Facing: No

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