Expert Clinical Policy Advisor

The Expert Clinical Policy Advisor develops, implements, and manages clinical and operational dental policies that support benefit design, claims processing, and provider engagement. This role ensures all policies are evidence-based, comply with regulatory and accreditation standards, and align with organizational and industry requirements.

Responsibilities:

• Develops and maintains clinical dental policies and guidelines in alignment with current evidence, industry standards, and organizational priorities.
• Evaluates existing clinical policies, systems, and procedures to ensure and improve efficiency, accuracy, and policy alignment across multiple enterprise departments. Evaluates opportunities for enhancement to promote accurate dental policy administration.
• Leads and/or contributes to clinical committees, policy review groups, and internal workstreams to support policy governance and continuous improvement. Supports the Clinical Policy Oversight Committee to ensure dental alignment across a governing body of dental consultants.
• Coordinates the review and maintenance of all internal and external clinical policy documents to ensure they are current and meet regulatory and organizational requirements.
• Acts as SME to the business in dental policy, guideline, and plan feasibility matters; provides training, policy updates and summaries, support for clinical responses, new plan evaluation, and assistance in the implementation of and compliance with special plan regulations such as Medicare/Medicaid.
• Supports audits and reviews of clinical policies by providing thorough documentation and rationale for policy decisions.
• Oversees dental policy documentation, training materials, change management, and transparency efforts, ensuring accuracy and consistency across a matrixed environment.
• Oversees, updates, and reviews Utilization Management (UM) sections of Dentist and Consultant Handbooks on an annual basis.
• Collaborates with internal stakeholders on issue resolution matters and process improvement projects.
• Supports dental care case studies to inform internal education, policy, and benefit changes as well as performance consulting matters.

• 7+ w/Bachelor's degree.
• A minimum of 4 years' experience in dental policy administration. DDS or DMD required.
• Excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
• Strong verbal, written, and interpersonal communication skills.
• Knowledge of dental policy and utilization management processes.
• Excellent critical thinking and problem-solving skills.
• Ability to maintain confidentiality and adherence to HIPPA.
• Proficient in Microsoft Office applications.
• Strong leadership skills with the ability to influence effectively.
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Knowledge of Current Dental Terminology (“CDT”) codes and dental nomenclature.
• Knowledge of health care industry issues preferred.
• Knowledge of Enterprise processing policies and guidelines for dental procedures, limitation and exclusions.

• Competitive base and incentive pay
• 401(k) with robust matching and non-matching contributions
• Rich medical & pharmacy benefits
• 100% employer-paid dental and vision benefits
• Holistic wellbeing program with deep financial incentives
• Generous paid time off plus 12 paid holidays and your birthday off
• Culture of growth and learning: career development; tuition reimbursement; recognition program
• Family support: adoption assistance, fertility treatment, child, elder & pet care assistance
• Social responsibility and volunteer opportunities
• Employee discount program