Dental Director, Clinical Advisor

Blue Shield of California; California (MO); Hybrid; USD 203,000 - 208,000; Full time

Job summary

A leading health care organization, Blue Shield of California is looking for a Dental Director, Clinical Advisor. In this critical role, you will provide leadership in dental program specialty, oversee clinical quality, and ensure compliance with state and federal regulations, all while promoting innovative approaches to healthcare delivery.

Qualifications

• Doctor of Dental Science (DDS) degree or Doctor of Dental Medicine (DMD) required.
• Minimum 5 years direct patient care experience post residency.
• Familiarity with regulatory compliance and quality improvement activities.

Responsibilities

• Provide clinical oversight of dental specialty program and services.
• Establish utilization matrix and evaluate existing Blue Shield Dental policies.
• Drive regulatory compliance adherence and lead corrective action efforts.

Skills

Leadership

Clinical expertise

Communication

Education

Doctor of Dental Science (DDS) or Doctor of Dental Medicine (DMD)

Completed dental residency training

Tools

Microsoft Excel

Microsoft Word

Job description

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Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Dental Director will report to the Sr. Medical Director, Operations. In this role you will provide leadership and guidance on dental program specialty for Blue Shield of California.

Job Description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Dental Director will report to the Sr. Medical Director, Operations. In this role you will provide leadership and guidance on dental program specialty for Blue Shield of California.

The Dental Director provides clinical expertise and consultative support to the organization related to dental. They are responsible for consulting and advising on care management, population health management and all other appropriate areas. Moreover, the Dental Director meaningfully contributes to the Blue Shield priorities and transformative initiatives that continue to improve the health and wellbeing of Blue Shield of California members. You will also provide direction and leadership in compliance with state and federal laws and regulatory requirements related to dental specialty.

Responsibilities

Your Work

In this role, you will:

• Provide Clinical oversight of dental specialty program and dental services vendors
• Establish a utilization matrix and provide an annual review of dental benefits. Ensure medical and dental integration for utilization management and care management
• In partnership with Product Strategy and Specialty organizations, evaluate existing Blue Shield Dental policies and benefits. Make recommendations for maintaining current benefits and policies or modifying them based on emerging trends and evidence-based dentistry
• Contribute to a thorough analysis and evaluation regarding dental benefits and coverage guidelines, to determine the business value, including cost analysis. Develop appropriate, sound recommendations on whether to implement the proposed new benefits/ benefit enhancements
• Serve as a dental thought leader within the organization and act as subject matter expert and advisor for product strategy, emerging technology trends, public policy, and mandates
• Analyze, evaluate, and make recommendations regarding emerging scientific research related to medical/dental integration
• Serve as the primary representative and as an active participant in Compliance Committee, Vendor Partner Quality Committee, Joint Operation Committee meetings, and other meetings or industry-related events as appropriate
• Drive regulatory compliance adherence and leads corrective action efforts with vendors and medical operations teams
• Complete dental services clinical reviews for services performed by vendors, including any applicable Prior Auth, Post Service, Appeals and Grievances or other reviews within compliance standards
• Provide recommendations based on appeals, grievances, and dispute trend
• Coordinate efforts with the enterprise to ensure dental is included in advocacy and other customer-facing activities to drive better health and improve overall costs
• Participate in Premier/National client review meetings, and broker and consultant meetings as a clinical expert contributing to strong dental retention, sales and marketing
• Attend other meetings or industry related events as appropriate
• Conduct clinical reviews for services provided or ordered by dentists, covered under the medical benefit, including Prior Authorization, Post Service evaluation, Appeals, and Grievances. Ensure all reviews are performed in accordance with compliance standards
• Attend mandatory Corporate Compliance Program education sessions, as required for this position, including the annual mandatory Standards of Conduct class
• Abides by all applicable laws and regulations as mandated by state and federal law
• Any other assigned duties
  
  

Qualifications

Your Knowledge and Experience

• Doctor of Dental Science (DDS) degree or Doctor of Dental Medicine (DMD)
• Completed dental residency training
• Active, unrestricted dental license in the state of California required
• Board certification in dentistry through American Board of Dental Specialties (ABDS) or American Board of General Dentistry (ABGD) preferred
• Minimum 5 years direct patient care experience post residency
• 5 years’ experience in managed care that can contribute to utilization management, case management, and/or quality improvement activities or other health care administrative operations at the IPA or health plan level, preferred
• Knowledge of Medicare, California statutes and regulations including DMHC. Understanding of NCQA accreditation standards preferred
• Knowledge of the wide ranges of psychosocial challenges, social determinants, and social needs
• An ability to work independently to achieve objectives and resolve issues in ambiguous circumstances
• Clear, compelling communication skills with demonstrated ability to motivate, guide, influence, and lead others, including the ability to translate detailed analytic analysis and complex materials into compelling communications
• Strong collaboration skills to effectively work within a team that may consist of diverse individuals who bring a variety of different skills ranging from medical to project management and more
• Excellent written and verbal communication skills
• Excellent analytical, time management and organizational skills
• Proficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint
  
  

About The Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
  
  

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
• Member-facing and approved out-of-state roles remain remote.
• Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
  
  

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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