AVP, QM & Clinical Oversight-CA Dental Director

AVP, QM & Clinical Oversight-CA Dental Director

Location(s): Bridgewater, NJ

Alternate Locations(s): Charlotte, NC, Cary, NC, or Irvine, CA

Setting: Hybrid

Reports to: Chief Dental Officer, VP

MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits and asset management to individual and institutional customers. We’re united by our purpose to help our customers and each other create a confident future; we’re guided by empathy; and we’re inspired by each other to make a difference in the lives of our coworkers, customers, communities, and the world at large. At MetLife, it’s #AllTogetherPossible. Join us!

The Opportunity:

In this role, you will develop and oversee quality and clinical programs including Provider Scorecard, Value Based Programs, and Utilization Management Programs. You will also serve as the California Dental Director for the DHMO product. You will chair multiple committees (Credentialing, Peer Review, and Grievance and Appeals). The person in this role will be responsible for differentiating MetLife in the market by developing and implementing Quality Management Programs. The AVP will provide subject matter expertise to all market segments and the Dental Product Development Team to support the growth of our business.

Dimensions of Position:

• Earnings:  Contributes to earnings by leading utilization management efforts through the development of data outlier-based outreach
• Revenue:  Impacts new business sales and retention of current business through creation of programs that will differentiate MetLife.
• Staff: Three existing MetLife employees

How You’ll Help Us Build a Confident Future (Key Responsibilities):

• California Dental Director - Assume all the roles and responsibilities currently performed by our CA dental director. 
   
• Direct revamped OAC Program/Utilization Management Program - Responsible for the creation of targeted outreach to offices that exhibit poor quality outcomes through scorecard metrics. These responsibilities have significant impact to both top line revenue and bottom-line earnings.
   
• Direct Value Based Program - Responsible for the implementation and monitoring of the Value Based Programs that ensure MetLife has a competitive advantage in many market sectors.
   
• Provide Subject Matter Expertise and Support for all Market Segments - Act as a support resource for all market segments including MetLife field representatives, National Account client service personnel, and the National Service Center.  These responsibilities include providing dental consultative services for plan design for clients, aiding the Chief Dental Officer’s participation in finalist sales presentations, providing a clinical resource in relation to client/field questions and claim resolution, and positioning MetLife’s value proposition in the marketplace. These responsibilities directly affect top line revenue through driving new sales growth and persistency of current clients.
   
• Thought Leadership: Responsible for the Development and Implementation of Disease Management Programs - This includes the design and initiation of the programming that is necessary for a disease management program. This initiative involves the coordination between MetLife, an outside vendor and current dental clients.  This program is a market differentiator from MetLife’s competitors.
   
• Set Clinical Policies for the Dental Product in Conjunction with the Chief Dental Officer - Provide the specifics around clinical policies as they relate to both the insured and ASO blocks of business. This includes the systematic review of the current dental research and literature that is pertinent in relation to claims processing, plan design, product development, and compliance.
   
• Support Dental Product Compliance - Own the process involving the Current Dental Terminology updates/revisions mandated by HIPAA including coordinating the clinical decisions with the Chief Dental Officer and initiating the necessary programming changes to the Claims system to ensure compliance. Serve as a representative for MetLife on both the NADP and AHIP current dental terminology committees. Act as a resource to the DPM compliance personnel for all matters related to both insured and ASO blocks of business.
   
• Develop Market Leadership - Deliver continuing education courses to the broker/consultant/agent community. Participate in the formation of oral health education materials that are disseminated to individuals covered by MetLife dental plans. Develop disease management plan design concepts.
   
• Lead Dental Product Management Team Responsible for Contract/Certificate Revisions - Act as the subject matter expert to drive programming changes to ensure compliance with the current versions of the contracts/certificates such as the “refer to medical” problem.  Serve on the contract revision team for updates to the current versions as well as the development of a new insured contract version.
   
• Act as Consultant for Dental Product Development Team - Serve as a subject matter expert for the development of new dental product offerings from a plan design concept including clinical, marketplace, and financial considerations.  Participate on the team from Product Development that is building the small market/mid large market common platform.
   
• Chair the Quality Management Committee for the Dental Product - Responsible for the Quality Management Committee for DPM that addresses issues of PDP grievances, balance billing, network credentialing, office audit low scoring dental offices and compliance complaints.
   

What You Need to Succeed (Required Qualifications):

• Licensed Dentist with the ability to obtain a CA dental license
• Advanced knowledge of insurance industry, quality, and clinical programs
• Knowledge / experience with supported products, market, industry, and business
• Strong ability to manage senior level professionals
• Strong communication and presentation skills
• Ability to drive results through direct lines of accountability and through partnership relationships
• Strong change leadership skills
• Strong professional business acumen
• Strong ability to hold people accountable and drive business results

Benefits We Offer:

Our U.S. benefit programs are geared toward health and wellness, financial protection, and retirement savings. In addition to comprehensive health coverage including medical/prescription drug, dental, vision, and no-cost short- and long-term disability benefits also include:

• Retirement plan (cash balance pension) with a minimum monthly contribution regardless of an employee’s pay and 401(k) with employer matching
• Company-paid life insurance and legal services, and discounts on voluntary insurance products including auto and home, pet, critical illness, hospital indemnity, and accident insurance
• Employee Assistance Program (EAP) and digital mental health programs
• Expert support for medical second opinions, cancer care navigation, diabetes and hypertension, weight loss/fitness, joint and spine health, caregiving, and more
• Generous paid time off, including a floating cultural heritage day
• Paid volunteer time off and charitable contribution match
• Tuition assistance
• Family benefits including paid parental leave, adoption and surrogacy assistance, child and eldercare support, college advising program

MetLife:

MetLife, through its subsidiaries and affiliates, is one of the world’s leading financial services companies, providing insurance, annuities, employee benefits and asset management to help its individual and institutional customers navigate their changing world. Founded in 1868, MetLife has operations in more than 40 countries and holds leading market positions in the United States, Japan, Latin America, Asia, Europe and the Middle East.

We are one of the largest institutional investors in the U.S. with $642.4 billion of total assets under management as of March 31, 2021. We are ranked #46 on the Fortune 500 list for 2021. In 2020, we were named to the Dow Jones Sustainability Index (DJSI) for the fifth year in a row. DJSI is a global index to track the leading sustainability-driven companies. We are proud to have been named to Fortune magazine’s 2021 list of the “World’s Most Admired Companies.”      

MetLife is committed to building a purpose-driven and inclusive culture that energizes our people. Our employees work every day to help build a more confident future for people around the world.

We want to make it simple for all interested and qualified candidates to apply for employment opportunities with MetLife.  For further information about how to request a reasonable accommodation, please click on the Disability Accommodations link below.

MetLife is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at MetLife without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.

MetLife maintains a drug-free workplace.