This position will be primarily responsible for the adjudication of dental claims and prospective requests for dental services (referrals and pre-authorizations) in Florida. Additionally, this person will participate in other clinical review activities in Florida, such as participating in Florida Quality Management and Improvement activities such as clinical review of FL grievances, and meeting with FL clients for periodic joint operational meetings. The position will be full or part time depending on volume and demand. The FL Dental Director also participates actively in Utilization Management and Review Programs. LIBERTY Dental Plan administers commercial, Medicare Advantage and Medicaid programs in Florida.
The Dental Director will report to the National Dental Director and will collaborate with other corporate Dental Directors to assist in the development of clinical guidelines and Qualify Management Improvement processes to ensure process improvement and consistency in all clinical activities across the enterprise, yet specializing in any unique FL requirements.
The FL Dental Director will be an active participant on the National Peer Review Committee in reviewing and analyzing Potential Quality Issues (PQIs), a member of Utilization Management Committee, Credentialing Committee and Quality Management & improvement Committee