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Manager, Dental Network Recruitment

Sapphire Digital

Sapphire Digital

Florida, USA · Remote
Posted on Tuesday, July 9, 2024

Position Overview

The Manager, Dental Network Recruitment is responsible for the overall contracting strategy and development of Zelis proprietary dental network (current and prospective) to increase the savings achieved for Zelis clients for existing and new products. Cultivate organization’s’ overall direct contracted PPO assets to support multiple products and achieve corporate objectives for PPO product viability.

Key Responsibilities

  • Executes, negotiates, conducts dispute resolution and/or settlement of contracts

  • Drives team of direct reports to work with larger groups/systems to grow dental provider networks while exceeding quality and financial saving initiatives

  • Networks with external stakeholders on behalf of Zelis (national dental conferences, industry trade organizations, consultants, etc.)

  • Negotiates complex contracts (including but not limited to Group Agreements, middle level practice agreements, fee negotiations)

  • Oversees a cost of care model to improve NED while driving access improvements

  • Establishes strategic relationships with all specialty type providers

  • Answers complex questions and provide information about procedures or contracts

  • Assists business operations with contract terms and educating company key personnel about such contract terms

  • Develops and provides plan support and contracting leadership

  • Compiles, maintains, and analyzes dental and Dental Service Organization (DSO) fee schedules to identify cost savings opportunities

  • Develops and communicates network development goals including target acquisitions, claim dollars captured, and revenue achieved

  • Provides continuous feedback and updates to organization’s direct contract strategy

  • Creates and manages tools necessary to capture provider targets, measure performance and provide feedback and recommendations to executive team

  • Recruit, coach and mentor Dental Recruitment staff

  • Acts on a variety of employee related activities including employment, termination, performance reviews, salary reviews, and disciplinary actions

  • Evaluates and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls

  • Up to 25% domestic travel, as required to meet business needs

Qualifications

  • Bachelor’s degree or equivalent experience

  • 5+ years of experience working in Dental Network Recruitment, in a leadership role

  • Advanced understanding of contract language and ability to explain according to audience

  • In-Depth level of knowledge of dental networks, dental Medicare Advantage (MA) networks, along with different payment methodology

  • In-Depth knowledge of provider contracting/negotiations, network development and configuration, Current Dental Terminology (CDT) codes and standards for managed care delivery and cost containment programs

  • In-Depth knowledge of managed care policy and direction

  • Strong knowledge of dental product lines and benefit offerings including PPO, Maximum Allowable (MAC), etc., understanding of both Commercial and Government dental business

  • Experience managing projects and process innovative changes effectively

  • Proven experience leading and managing high performing teams. Proficient in Network Development, Network Management, Provider Contracting, including credentialing standards

  • Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships

  • Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.g., partnering, conflict management, consulting, etc.)

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We’re Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity, Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you’re contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.