Dental Clinical Director

Centene Corporation

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose The Dental Clinical Director provides professional judgment to adjudicate prior authorization, claims, and appeals submissions to help Envolve Dental appropriately manage to state Medicaid, Marketplace, and federal Medicare utilization and expense control. Appropriate and clear adjudication decisions also contribute to member and provider satisfaction. The Dental Clinical Director also helps create, implement, and carry our dental clinical policy that is consistent with American Dental Association evidence-based guidelines and with the various dental specialty association guidelines. This is a highly visible and key role in maintaining Envolve Dental’s position and reputation in the dental insurance marketplace.

Review and decision prior authorization and claim submissions

Review and decision member and provider appeals

Participate on committees as requested

Develop and evaluate clinical policies

Provide guidance and subject matter expertise to health plans

Provide clinical specialty guidance to dental leadership

Education/Experience DDS/DMD degree required. 5 years of experience in dental claims and knowledge of dental or orthodontic care that comes with being a General Dentist or Specialty Dentist. License/Certification DDS or DDM degree and valid dental license.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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