Geisinger Health Plan (GHP) is seeking a medical director to lead the dental Government programs division. Qualifications for this position requires a board-certified DDS/DMD dentist with a preference toward providers with pediatric dental experience and previous experience as a medical director in a Managed Care Organization. The successful candidate will possess a dedication to the philosophy of managed care and continuous quality improvement of clinical care and service. The ability to communicate effectively at all levels of a large complex organization is essential. Experience with Government programs, specifically Medicaid, is a plus. This position will report directly to the Health Plan Chief Medical Officer.
About the position:
Provides clinical expertise on oral health and dental industry issues with special attention to the needs of low income populations.
Leads relationship development with participant Medicaid and CHIP network dentists
Collaborates with the Pennsylvania Department of Human Services and other MCO Dental Directors on all aspects of oral health related to low income populations in the Commonwealth
Work with other Departments within GHP and Geisinger as well as working with the communities to raise awareness regarding oral health
Works collaboratively with the Dental Benefit Manager (DBM) in all aspects of oral/maxillofacial care, including the development of an adequate, high-performing network.
The position will be 70% GHP and 30% clinical practice
Responsible for the continued development and implementation of the GHP Management Plan for oral health.
Work closely with GHP Medical Directors to further manage medical/dental goals in each GHP coverage area.
Supports as appropriate the dental component of retrospective claims audit/claims check.
Supports the Evidence of Insurability and Over Age Dependent process.
Provides guidance and interpretation on issues of dental appropriateness, benefit application, and level of care necessary to include out of network care.
Assure proper and complete documentation of all necessary paperwork within the required timelines.
Participates in Appeals Committee activities.
Responsible for auditing DBM activities and tracking monthly statistics.
Responsible administratively for the practitioner, provider appeals process, as it relates to Dental providers, along with the Medical Director for Provider Network Management
Participates on the Plan Pharmacy & Therapeutics Committee.
Responsible for collaboration with pharmacy department to monitor utilization of medications by oral health providers
Reports any quality concerns to the QI Department for investigation.
Participates in the Medical Care Review Committee.
Participates on the Quality Improvement Committee (“QIC”).
Functions as a member of the Health Plans operations team and administrative staff.
Responsible for implementation of Geisinger Health Plan policy and procedures in a supervisory capacity.
Participates on Geisinger Health Plan Quality Improvement Committee and/or any one of its subcommittees.
Participates in weekly Medical Directors meeting.
Participates on Medical Management Committee.
Geisinger Health Plan (GHP) is the health insurance component of Geisinger Health System and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries*.
*PPO and high deductible plans are sold through Geisinger Quality Options, Inc. Self-funded plans are sold through Geisinger Indemnity Insurance Company.
For more information, please visit geisinger.org/careers or contact: Stephanie Figueroa, Talent Acquisition Specialist, email@example.com
Internal Number: -
About Geisinger Health System
Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family. Geisinger is nationally recognized for innovative practices and quality care. A mature electronic health record connects a comprehensive network of 13 hospital campuses, two research centers and nearly 1,600 Geisinger primary and specialty care physicians.Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care delivery models such as ProvenHealth Navigator®, ProvenCare® and ProvenExperience®. As one of the nation’s largest health service organizations, Geisinger serves more than 3 million residents throughout 45 counties in central, south-central and northeast Pennsylvania, and also in southern New Jersey at AtlantiCare, a Malcolm Baldrige National Quality Award recipient. In 2017, the Geisinger Commonwealth School of Medicine and Geisinger Je...rsey Shore Hospital became the newest members of the Geisinger Family. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan, all of which leverage an estimated $12.7 billion positive impact on the Pennsylvania and New Jersey economies. Geisinger has repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.