Provider Network Director

Job Title: Provider Network Director Number of Positions: 1 Location: DDMI - Nashville Location Specifics: Hybrid Position Job Summary: Must reside in Metropolitan Davidson County, Tennessee or a county contiguous to Metropolitan Davidson County, Tennessee. At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture. It’s a mindset, feeling and attitude we wrap around all that we do – from taking charge of our careers, to helping colleagues and lending a hand in the community. Position Description Plans, organizes, evaluates, and directs Tennessee Medicaid network activities to ensure continuous improvement of programs and services for TennCare. Primary Job Responsibilities Directs and evaluates Tennessee Medicaid network activities to ensure continuous improvement of programs and services for TennCare, and ensures providers have access to resources to answer questions pertaining to the program, including appropriate and timely responses regarding PA requests. Directs, develops, evaluates and implements network adequacy reports and process improvement strategy to ensure provider enrollment and Insure Kids Now files are current and accurate. Ensures TennCare ECF CHOICES DBM Program and TennCare 1915(c) DBM Program participating dental providers are clearly identified. Interviews, hires, evaluates and develops staff in order to ensure accountability for achievement of department goals and objectives. Develops, recommends and oversees implementation of new network programs. Develops and implements short and long term strategy, goals and objectives. Coordinates and oversees dental provider education activities and communications. Develops, recommends and monitors the annual departmental budget. Develops, recommends and enforces policies, procedures, guidelines and standards of operation. Communicates with and advises executive management on the planning and activities of government business. Supports in establishing analytics function within the government programs business unit that is integrated into decision-making. Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above. Minimum Requirements: Position requires a bachelor’s degree in business administration or a related field, seven years of related experience in the business of healthcare (dentistry preferred), and two years of management experience. Will accept any suitable combination of education, training, or experience. Position requires being physically located in Metropolitan Davidson County, Tennessee, or a county contiguous to Metropolitan Davidson County. Position requires advanced knowledge of medical terminology and procedures (dental preferred), as well as dental profession and insurance products, strong verbal and written communication skills; strong analytical skills; and the ability to analyze and resolve complex problems using independent judgment. The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance. Delta Dental of Michigan, Ohio, and Indiana has been a dental benefits leader for more than 60 years, and today with our affiliates, we are one of the largest dental plan administrators in the country. It’s our mission to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by making investments that build healthy, smart, vibrant communities. We celebrate diverse thought and foster a culture where employees go All In – for the company, themselves, their colleagues and their communities. Employees are offered a comprehensive benefits package that includes medical, dental and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on-staff health coach and personal trainer, plus many other perks. Delta Dental is an Equal Opportunity Employer. Apply tot his job Apply To this Job