Director, Gov Programs

The Director of Government Programs will oversee the utilization review processes for all states and all Sonrava Health/Western Dental facilities (ADS, BHD, Brident, STX, etc.) and their success based on metrics as outlined within each Program. Produce quarterly dashboards for the Ops team that reflect utilization and metric success within all offices and all Government Programs. Provide solutions for those offices failing to reach monthly and quarterly goals. Identify offices not meeting monthly quarterly metrics, work directly with the Ops and training team to create an effective training tool to produce desired outcomes. Build case for expanded membership assignment using data and tight management process. Collaborate with the Marketing team to develop effective outreach materials that will be successful in increasing membership into the office. Participate in Community Outreach to attend important events that provide substantial visibility, creating additional avenues to outreach to assigned and unassigned government membership. Generates dashboard reports specifically for the Senior Management and Executive Team members with clear and concise information. As a leader, fosters a culture within the Payor Relations department that reinforces customer service, teamwork and operational efficiency.

• Responsible for coordination of new contract implementation, working in conjunction with Operations, IT, Training and Offices
• Responsible for Payor relationships to resolve issues, seek clarification and represent Western Dental on operational issues
• Compiles all Government data analyzes the information and create dashboards to illustrate KPI and presents this information to Senior Management and the Executive level team
• Reconciles monthly capitation data for retro debits and adjustments
• Identify facilities that fall below metric thresholds, create CAP
• Create training tools and collaborate with Operations and the Training department to facilitate regular courses and updates
• Work closely with Business Managers and District Managers to meet all metrics
• Brainstorm marketing techniques to increase member appointments and show rate
• Work closely with the Community Outreach team to identify opportunities to increase Market Branding
• Present all methods of compensation through quality metric compliance
• Attend Government related meetings, i.e. MDAC, LA Stakeholders
• Handles all CAP directed by Government Programs
• Work directly with Payer Relations for decreasing or missing compensation or decreases in membership
• Other duties as identified by management
  
  
  

Salary Range $115,000.00 - $140,000.00

• B.A. or B.S. Degree Required
• Previous Supervisor Experience Required
• Previous Experience performing statistical and financial analysis
• Above average problem-solving skills and attention to detail
• MS Office with Advanced Excel skills
• Excellent Communication and presentation skills