Director, Provider Engagement DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The Opportunity:

The Director, Provider Engagement (PE) is responsible for overall provider network experience, performance and compliance. The Director strategically analyzes, manages, and reports on the provider network and related activities regarding all programs and products including Medicaid, Medicare Advantage, Marketplace, and Commercial (and any blend of products, e.g., dual eligible), and is responsible for the P&L (cost of care and loss ratio) of the network(s). These duties include but are not limited to the development and oversight of access, cost, and quality measurements to ensure network compliance, client satisfaction, sales support, optimized provider performance, and improved outcomes. The Director maintains ultimate oversight of as

signed provider engagement staff, and therefore provides clear direction, ongoing education to include professional development, and daily activity monitoring tools for reporting purposes. This position interfaces and collaborates with multiple internal operational areas, as well as face to face and virtually with clients, representing the organization as the network Subject Matter Expert.

How you will contribute:

• Oversee the development and execution of, as well as provide support and direction to, the Provider Engagement team in support of all products

• Own applicable P&Ps, SOPs, SLAs and ensure compliance with them

• Develop innovative, competitive, cost effective and quality networks for all products in support of new sales and existing client retention

• Champion provider adoption/utilization of digital platforms/tools

• Provide support and direction to the team to ensure appropriate allocation of resources to meet multiple deliverables and participate in a wide range of network focused initiatives

• Establish provider network targets, recruit/contract new providers and work with existing providers to move them along the cost and quality continuum.

• Develop strategies to increase member access, preventive care, increase quality and outcomes, while decreasing costs

• Collaborate with other areas to ensure members assignments and dental home programs meet cost, quality, access and capacity goals

• Review and submit for approval special deal requests, retroactive adjustments, reimbursement, and contract exceptions

• Use available tools and resources to conduct Network Adequacy, Compliance, Validation, Accuracy, Appointment Availability, and other related activities as required/needed

• Collaborate with other enterprise functions to drive improvements in Provider Data Integrity

• Support and assist credentialing to obtain missing credentialing information

• Collaborate with Marketing, Communications, Governmental Relations, Clinical and Client teams to position the organization favorably and achieve desired business results

• Partner in responding to Request for Proposals (RFPs) to illustrate network strategies as a competitive advantage to grow new business and retain existing business

• Strategize with analytics and other teams on best approaches for collection, evaluation, compilation, and dissemination of data consistent with requirements and goals

• Assess environmental trends, needs, and opportunities to inform decision makers internally and externally on opportunities to execute provider programs that achieve annual business goals.

• Monitor portfolio of contract operations ensuring successful execution of operating plan objectives and achievement of outcome/success measures for Providers

• Develop and manage department budgets and resources consistent with short and long term financial and operational goals

• Proactively research competitors' provider panels; fee schedule and reimbursement methodologies; policies and procedures; tools and technology; processes, etc.; and make recommendations to meet or exceed competition

• Build and maintain relationships with leaders of local dental associations, FQHCs, Public Health, dental schools, large group practices and other key provider stakeholders

• Collaborate with Client team to meet network needs and participate in on-site meetings, virtual meetings, conference calls, and day-to-day interaction with clients, prospective clients, organized dentistry, and other key industry stakeholders

• Direct team on the appropriate preparation of client audits, CAPs, and ad hoc report documents

• Oversee other engagement activities and projects related to the provider network

• Ensure internal and external network reports are prepared and delivered accurately and timely

• Develop solutions to improve participating provider satisfaction and innovative approaches to advance recruitment strategies to attract providers to join all lines of business

• Develop and maintain provider reimbursement models in line with cost of care goals, market research and profitability/loss ratio objectives, using effective negotiating strategies

• Draft Provider Agreements, Restated Agreements, Amendments, and other communications as needed and by working with legal and marketing

• Organize, assess and problem solve workflows with other departments to ensure efficient, timely and accurate outcomes

• Coordinate and implement appropriate performance management strategies for team members to include:

  • Assist in the hiring process, including interviewing candidates

  • Assist, train and motivate team members to Evaluate and measure effectiveness of team members

  • Assist in preparation of performance and wage evaluations in accordance to company policy

  • Responsible for attendance and company approved time off for team members

  • Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives.

• Design reports to effectively manage team members

• Train and coach team to be knowledgeable in all aspects of their role and responsibilities

• Other duties as assigned.

What you will bring with you:

• Bachelors degree in business, healthcare administration, or related/applicable degrees, e.g., marketing, communications, finance, etc.

• Ten (10) years of related experience in management with experience in business or healthcare administration, finance or another related field preferred

• Ten (10) years of demonstrated leadership in the development, monitoring, and successful implementation of organizational strategy

• Ten (10) years of experience in client and provider relationship management

• Five (5) years of experience in process or operational management

• The ability to think analytically, decipher and understand complex data

• The ability to design and manage complex organizational policies and communications and obtain corporate and divisional cross functional support

• The ability to design and manage complex organizational policies and communications

• Ability to manage multiple projects simultaneously

• Comprehensive knowledge of the healthcare industry and payment methodologies, including Value Based or Alternative Payment Models

• Demonstrated skill in recruiting, training, coaching, managing, motivating and developing staff

• Demonstrated skill in financial and budget management

• Executive-level written and verbal communication, presentation, interaction and persuasive skills

• Demonstrated skill in high-level decision-making and problem-solving

• Proficiency with general computer software (Excel Word, and PowerPoint)

• Ability to work in a fast-paced, results-driven environment

Salary:

Salary Range: $129,800 - $194,700

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.comto request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.