Massachusetts Veterans Jobs

Why This Role is Important to Us:

The Program Manager, Dental plays a pivotal role in managing the day-to-day operations. This role requires a keen attention to detail, strong organizational skills, and effective communication abilities. The program manager will be primarily focused on overseeing vendor day-to-day operations while demonstrating strategic vision in developing and enhancing oversight management.

Responsibilities include: vendor oversight, member and provider experience management and improving program process to ensure a seamless experience for program beneficiaries.

This role requires a proactive, organized, and adaptable professional who can navigate complex interactions with vendors and provide exceptional indirect support to program beneficiaries.

What You'll Be Doing:

Operational Excellence:

• Efficiently manage day-to-day operations of dental program within the health plan

• Ensure compliance with regulatory requirements and industry standards.

• Oversee claims processing, provider relations and member inquires related to dental benefits.

Vendor Oversight:

• Collaborate with contracted vendors to ensure smooth execution of program services.

• Monitor vendor performance, adherence to contract terms, and service level agreements.

• Establish and maintain strong working relationships with vendors through regular communication and meetings.

• Address any vendor-related concerns promptly and ensure compliance with program standards.

Issue Resolution:

• Act as the point of contact for escalated inquiries, issues, and escalations.

• Collaborate with cross-functional teams to address and resolve complex member issues.

• Analyze root causes of member complaints and work on preventive solutions.

• Ensure compliance with regulatory guidelines while resolving member issues.

Data Analysis and Reporting:

• Analyze program data to identify trends, patterns, and areas for improvement.

• Prepare regular reports on program performance, member feedback, and vendor compliance.

• Make recommendations based on data analysis to enhance program effectiveness.

Program & Process Improvement:

• Develop and implement strategic plans for the enhancement and expansion of dental programs.

• Stay informed about industry trends, emerging technologies and best practices.

• Collaborate with cross-functional teams to identify opportunities for program growth & improvement.

• Continuously assess program operations and identify opportunities for process optimization.

Regulatory Compliance:

• Stay informed about relevant Medicare regulations, guidelines, and updates.

• Ensure the program operates in accordance with all regulatory requirements.

Collaboration:

• Build and maintain strong relationships with dental providers, ensuring network adequacy and quality.

• Collaborate with internal teams to integrate dental benefits seamlessly into overall health plan offerings.

• Act as a liaison between CCA and external stakeholders, fostering positive relationships.

What We're Looking For:

Education Required:

• Bachelor's degree in a related field (healthcare management, business administration, etc.) or equivalent experience.

Experience Required:

• Requires 3-5 years of experience in dental program management including third party administration, health plan or managed care environment,

• Must be proficient at oversight and management of programs and/or vendors with demonstrated experience occurred within health plan, benefit administrators, consulting, business/strategic planning, and/or project management.

• Some experience with influencing a diverse group of stakeholders.

• Experience in third party vendor management, contract negotiation, and issue resolution.

• Proficient in using office software (e.g., Microsoft Office, Excel).

Experience Desired:

• Familiarity with Medicare/ Medicaid regulations and guidelines is preferred.

• Familiarity with dental quality of care guidelines and CDT coding.

Knowledge, Skills & Abilities:

• Strong analytical skills with the ability to interpret program and vendor performance data and make recommendations.

• Excellent interpersonal and communication skills.

• Detail-oriented and able to multitask effectively.

• Problem-solving mindset and ability to work well under pressure.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.