Clinical Quality Improvement Specialist, Dentaquest (Remote)

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Must live in Tennessee.

Job description

• Network with community organizations, providers and MCO to increase oral health awareness.
• Develop member outreach and wellness initiatives related to improvements in oral health outcomes and oral health literacy.

Preferred skills

• Knowledge of the Medicaid program requirements is preferred.
• College degree in a related field is preferred.
• Knowledge of healthcare advocacy activities is preferred.
• Experience working in a managed care environment, community organizations or public health is preferred.

Qualifications

• 2 years job related experience
• Frequent travel minimally 50% of the time
• Attention to detail, accuracy and organizational skills.
• Effective interpersonal skills.
• High School Diploma or GED required.
• Effective oral communication and business writing skills.
• Ability to prioritize and adapt to changing priorities.
• Required to attend additional training as requested/deemed necessary.
• Ability to travel long distances.

Responsibilities

• Represent the company in a professional manner at all times.
• Develop educational materials and training tools in accordance with federal and state requirements for non-dental healthcare providers, managed care organizations and community organizations to engage them in the effort to educate Medicaid enrollees on the importance of oral health.
• Track and monitor performance measures and report results to management and state agency if applicable.
• Autonomously provide enrollees with guidance and referrals during events based on information gathered during interactions with enrollees and results of dental screening.
• Complete special projects as requested.
• Collaborate with internal teams including marketing, data science and national outreach and connect with external community groups and state agencies to develop and execute customized outreach strategies for improving oral health outcomes of enrollees.
• Communicate to management ways to improve processes and productivity of company.
• Provide enrollee care coordination including collaboration with Case Managers,Client Engagement and/or Provider Engagement to facilitate enrollee access to care.
• Implement enrollee outreach and education programs with the goal of improving oral health literacy as well as ensuring compliance l with contractual requirements.
• Independently organize, plan and source community opportunities to participate in events (health fairs, faith-based organizations, schools etc) to provide enrollees with education on oral health and when feasible secure provider to conduct onsite dental screenings.
• Develop and implement strategy to increase enrollee utilization to and achieve dental EPSDT goals as required by client contract and/or goals.
• Manage workflow, time and program interventions within budget parameters and contractual timelines.
• Establish and maintain professional relationships with client and community contacts.
• Establish community relationships and partnerships that provide for participation in health care initiatives and programs in the dental and medical public health arena to create dental and program awareness.
• Attend and plan events throughout the state based on results of EPSDT metrics, county demographics and utilization patterns. Ensure events are distributed equally throughout the state, rural and urban areas and comply with quota and requirements of the contract.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Customer Service / Operations

29/10/2023

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran