Director, Provider Engagement DentaQuest

OverviewSun 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.The OpportunityThe 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 assigned 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 contributeOversee the development and execution of, as well as provide support and direction to, the Provider Engagement team in support of all productsOwn applicable P&Ps, SOPs, SLAs and ensure compliance with themDevelop innovative, competitive, cost effective and quality networks for all products in support of new sales and existing client retentionChampion provider adoption/utilization of digital platforms/toolsProvide 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 initiativesEstablish provider network targets, recruit/contract new providers and work with existing providers to move them along the cost and quality continuumDevelop strategies to increase member access, preventive care, increase quality and outcomes, while decreasing costsCollaborate with other areas to ensure members assignments and dental home programs meet cost, quality, access and capacity goalsReview and submit for approval special deal requests, retroactive adjustments, reimbursement, and contract exceptionsUse available tools and resources to conduct Network Adequacy, Compliance, Validation, Accuracy, Appointment Availability, and other related activities as required/neededCollaborate with other enterprise functions to drive improvements in Provider Data IntegritySupport and assist credentialing to obtain missing credentialing informationCollaborate with Marketing, Communications, Governmental Relations, Clinical and Client teams to position the organization favorably and achieve desired business resultsPartner in responding to Request for Proposals (RFPs) to illustrate network strategies as a competitive advantage to grow new business and retain existing businessStrategize with analytics and other teams on best approaches for collection, evaluation, compilation, and dissemination of data consistent with requirements and goalsAssess environmental trends, needs, and opportunities to inform decision makers internally and externally on opportunities to execute provider programs that achieve annual business goalsMonitor portfolio of contract operations ensuring successful execution of operating plan objectives and achievement of outcome/success measures for ProvidersDevelop and manage department budgets and resources consistent with short and long term financial and operational goalsProactively research competitors' provider panels; fee schedule and reimbursement methodologies; policies and procedures; tools and technology; processes, etc.; and make recommendations to meet or exceed competitionBuild and maintain relationships with leaders of local dental associations, FQHCs, Public Health, dental schools, large group practices and other key provider stakeholdersCollaborate 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 stakeholdersDirect team on the appropriate preparation of client audits, CAPs, and ad hoc report documentsOversee other engagement activities and projects related to the provider networkEnsure internal and external network reports are prepared and delivered accurately and timelyDevelop solutions to improve participating provider satisfaction and innovative approaches to advance recruitment strategies to attract providers to join all lines of businessDevelop and maintain provider reimbursement models in line with cost of care goals, market research and profitability/loss ratio objectives, using effective negotiating strategiesDraft Provider Agreements, Restated Agreements, Amendments, and other communications as needed and by working with legal and marketingOrganize, assess and problem solve workflows with other departments to ensure efficient, timely and accurate outcomesCoordinate and implement appropriate performance management strategies for team members to include: Assist in the hiring process, including interviewing candidatesAssist, train and motivate team members to Evaluate and measure effectiveness of team membersAssist in preparation of performance and wage evaluations in accordance to company policyResponsible for attendance and company approved time off for team membersParticipate in the determination and implementation of Performance Improvement Plans and performance management initiatives.Design reports to effectively manage team membersTrain and coach team to be knowledgeable in all aspects of their role and responsibilitiesOther duties as assigned.What you will bring with youBachelors 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 preferredTen (10) years of demonstrated leadership in the development, monitoring, and successful implementation of organizational strategyTen (10) years of experience in client and provider relationship managementFive (5) years of experience in process or operational managementThe ability to think analytically, decipher and understand complex dataThe ability to design and manage complex organizational policies and communications and obtain corporate and divisional cross functional supportThe ability to design and manage complex organizational policies and communicationsAbility to manage multiple projects simultaneouslyComprehensive knowledge of the healthcare industry and payment methodologies, including Value Based or Alternative Payment ModelsDemonstrated skill in recruiting, training, coaching, managing, motivating and developing staffDemonstrated skill in financial and budget managementExecutive-level written and verbal communication, presentation, interaction and persuasive skillsDemonstrated skill in high-level decision-making and problem-solvingProficiency with general computer software (Excel Word, and PowerPoint)Ability to work in a fast-paced, results-driven environmentSalarySalary Range: $129,800 - $194,700At 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.Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!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 LifeAt 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 accommodation s 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 to 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.Job Category: Sales - Client Relationship ManagementPosting End Date: 30/10/2025 #J-18808-Ljbffr

Created: 2025-09-28