Utilization Management Dental Director- Texas

The Dental Director is responsible for providing clinical oversight to promote member oral health, analyzing and adjudicating claims, appeals, and potential quality of care issues. They will assist in designing, developing, and implementing policies and procedures, provide dental interpretation for services, review claims consistent with current professional standards, and resolve provider and member grievances. The role also involves advancing the clinical vision for oral health through technology and data science, participating in policy and criteria development for claim review, providing guidance on dental product design, offering clinical input to Humana departments, conducting quality of care reviews, and working with the Specialty Quality Manager on the annual quality work plan and chairing the quarterly Specialty Quality Improvement Committee.