Senior Director Clinical Quality and Policy

Delta Dental; Alpharetta (GA); On-site; USD 260,000 - 340,000; Full time

Job summary

Delta Dental seeks a Senior Director of Clinical Quality & Policy to lead enterprise clinical policy, quality strategy, and utilization management. The role focuses on evidence-based care, data-driven decisions, and whole-person health outcomes, influencing enterprise priorities and market positioning.

The leader will oversee Utilization Management, Clinical Review, and Clinical Quality, collaborating with providers and executive stakeholders to align clinical policy with business goals and

Qualifications

• DDS or DMD required and dental license.
• 12+ years w/Bachelor's degree and 3+ years management.
• 10 years of transformational leadership experience in dental/health plan or related healthcare environments
• Experience applying evidence-based practice, clinical research, or scientific literature to policy or care model decisions
• Proven ability to influence senior leaders across a complex, matrixed organization

Responsibilities

• Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
• Influence provider strategy by translating clinical standards and quality priorities into guidance and engagement approaches.
• Shape the organization's clinical positioning through thought leadership, external credibility, and strategic partnerships.
• Develop and govern dental clinical protocols, standards of care, and evidence-based guidelines; ensure policies reflect best practices and oral-systemic health principles.
• Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight.

Skills

Strategic leadership

Verbal and written communication

Education

DDS or DMD

Job description

The Senior Director of Clinical Quality & Policy provides enterprise clinical leadership for a transforming dental health plan, ensuring that clinical policy, quality strategy, and utilization management are grounded in evidence-based care, data-driven decision-making, and whole-person health outcomes. This leader will be accountable for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, while also helping shape the organization's broader clinical positioning in the marketplace and supporting the development of integrated care models that connect oral health to whole person health. The Senior Director brings strong clinical credibility, policy expertise, business acumen, and strategic leadership to help influence enterprise priorities, provider engagement, quality outcomes, and market differentiation. This leader moves confidently between strategy and execution while bringing the credibility to engage with providers and clinical leaders, the business acumen to influence enterprise decisions, and the vision to help position the organization more broadly in the marketplace as a trusted health plan focused on quality, whole person care, and improved outcomes This role operates as a peer executive leader and consensus builder across clinical, operational, and enterprise stakeholders.

Responsibilities

• Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
• Influence provider strategy by helping translate clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches.
• Help shape the organization's clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships.
• Ensures the policies that orients company and providers to delivery patient health through policy design, policy execution and policy compliance. Develop and govern dental clinical protocols, standards of care, and evidence-based guidelines. Ensure clinical policies reflect best practices, emerging science, and oral-systemic health principles. Chair or co-chair clinical policy governance forums and guide consensus-based clinical decision-making. Translate clinical policy into clear clinical intent that informs utilization management and quality programs.
• Enables continuous Clinical Quality Improvement - Advance Quality & Outcomes. Provide quality leadership focused on outcomes, effectiveness, variation reduction, and continuous improvement. Oversee clinical quality programs that monitor member outcomes, safety, and care appropriateness. Use data and analytics to identify opportunities to improve clinical performance, care efficiency, and member experience. Operate as a consensus builder who brings stakeholders together around shared clinical and quality objectives.
• Drive Strategy, Innovation & Transformation Help shape the organization's clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships. Align dental clinical strategy with broader business goals, including growth, innovation, and integrated care. Contribute to initiatives focused on medical-dental integration, oral-systemic health, and whole-person care.
• Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight. Serve as a trusted clinical voice for internal stakeholders and external partners. Represents Delta Dental of California and affiliated companies when working with industry representatives.

Minimum Qualifications

• 12+ years w/Bachelor's degree; 3+ years management

Additional Experience

• DDS or DMD required
• Active, unrestricted dental license, or ability to obtain appropriate licensure if required
• Minimum of 10 years of transformational leadership experience in dental, managed care, health plan, payer, or related healthcare environments
• Significant experience in clinical quality, utilization management, clinical review, and clinical policy
• Demonstrated experience in both direct clinical care and administrative leadership
• Experience applying evidence-based practice, clinical research, or scientific literature to clinical policy, quality, or care model decisions
• Proven ability to influence senior leaders and work effectively across a complex, matrixed organization
• Strong strategic thinking and ability to translate clinical expertise into business and operational impact
• Senior-level leadership experience in clinical quality, clinical policy, utilization management, or related roles within a health plan, healthcare organization, or integrated care environment.
• Strong executive presence with the ability to influence, build consensus, and lead through change.

Knowledge, Skills, Abilities

• Advanced knowledge of managed care principles
• Verbal and written communication skills
• Den