Hybrid Dental Programs Lead — Government Utilization & Appeals

Delta Dental of Michigan; Detroit (MI); Hybrid; USD 180,000 - 240,000; Full time

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking an Associate Dental Director for Government Programs Dental Consulting and Utilization Management in Okemos, MI (hybrid). You will oversee clinical staff and guide utilization management across government programs, ensuring compliance and high-quality determinations.

This role requires a DDS/DMD with a decade of dental practice, state licensure, and experience with Medicaid/Medicare or similar programs.

Qualifications

• DDS/DMD from an accredited dental school.
• Current, unrestricted dental license including state licensure.
• Ten years of clinical dental practice experience.
• Experience with Medicaid/Medicare Advantage or dual eligible programs preferred.
• Ability to review and resolve complex clinical and benefit issues.

Responsibilities

• Performs claims adjudication and processing in compliance with federal/state rules.
• Assigns and adjusts clinical worklists to meet turnaround times.
• Monitors productivity, quality, turnaround times, and interrater reliability.
• Coordinates client/state regulatory and accreditation requirements.
• Provides complex clinical determinations for claims, authorizations, and appeals.
• Provides subject matter expertise for clinical system requirements and testing.
• Maintains training materials and delivers onboarding and training for staff.
• Participates in clinical/operational meetings with customers and state partners.
• Supports provider and claim audits and referrals for billing issues.
• Participates in policy/claims meetings and coordinates follow-up actions.

Skills

Dentistry knowledge

Radiograph interpretation

Communication skills

Interpersonal skills

Independent judgment

Education

DDS/DMD degree

Job description

Delta Dental of Michigan, Ohio, and Indiana is seeking an Associate Dental Director for Government Programs Dental Consulting and Utilization Management in Okemos, MI (hybrid). You will oversee clinical staff and guide utilization management across government programs, ensuring compliance and high-quality determinations.

This role requires a DDS/DMD with a decade of dental practice, state licensure, and experience with Medicaid/Medicare or similar programs.