Remote

Expert Clinical Policy Advisor

Delta Dental of California
$92,500 - $200,400
dental insurance, paid time off, paid holidays, tuition reimbursement, 401(k), employee discount
United States
May 30, 2025
JOB DESCRIPTION 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. QUALIFICATIONS 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. Licenses * DDM - Doctor Of Dental Medicine. Upon Hire Required * DDS - Doctor Of Dental Surgery. Upon Hire Required Base Pay Information The national base pay range at the end is a good-faith estimate of what Delta Dental may pay for new hires. Actual pay may vary based on Delta Dental's assessment of the candidate's knowledge, skills, abilities (KSAs), related experience, education, certifications and ability to meet required minimum job qualifications. Other factors impacting pay include prevailing wages in the work location and internal equity. Pay Grade 22. $92,500 - $200,400 ADDITIONAL INFORMATION Behind the smile! We are dedicated to safeguarding the health and financial stability of our employees and their loved ones. This commitment extends beyond the workplace to foster personal growth and holistic wellbeing. Our life-changing rewards package includes: 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 Fair Chance Ordinances and Criminal Background Considerations This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A. #LI-Remote ABOUT THE TEAM At Delta Dental, we're behind millions of smiles and counting. For over 68 years, we've served our communities by increasing access to affordable, quality care - but that commitment to care extends beyond the people we serve, to the dedicated employees who make those smiles genuine. We've come this far by building fair programs that offer opportunities for advancement, create meaningful connections and improve the lives of our employees and their families. Because we know that when we take exceptional care of each other, we can make a positive impact for all. We champion an inspirational workplace through our commitment to trust, service, excellence and innovation. Joining us means working for a company that offers stability and balance, opportunities for leadership at all levels, and a work environment focused on teamwork and camaraderie. Discover the smiling faces behind Delta Dental and experience our values and culture in action by connecting with us on social media. Follow Delta Dental Ins. on Facebook and Instagram, #LifeatDDins on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn. If you've got an appetite for innovation and want to be a part of a team that's transforming the future of health care, join us! Since 1955, we have offered comprehensive, high-quality oral health care benefits to millions of enrollees and built the strongest network of dental providers in the country. The Delta Dental of California network includes affiliates Delta Dental Insurance Company; Delta Dental of Pennsylvania; Delta Dental of New York, Inc.; Delta Dental of the District of Columbia; Delta Dental of Delaware, Inc.; and Delta Dental of West Virginia, providing dental benefits to more than 31 million people across 15 states, the District of Columbia, Puerto Rico and the Virgin Islands. The company and its affiliates are part of Delta Dental Plans Association (DDPA), a not-for-profit national association based in Oak Brook, Illinois. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories. We offer vision coverage through DeltaVision in 15 states and the District of Columbia. Collectively, we deliver benefits to more Americans than any other dental insurance company. Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment-Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies. Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time. Proof of eligibility to work in the United States must be provided if selected for hire. Delta Dental includes: Delta Dental of California, Delta Dental Insurance Company, Delta Dental of Pennsylvania, and Delta Dental of New York If You Are A Current Employee Click Here* To Apply