Senior Director Clinical Quality and Policy

About the role

The Senior Director of Clinical Quality & Policy provides enterprise clinical leadership for a transforming dental health plan, ensuring that clinical policy, quality strategy, and utilization management are grounded in evidence-based care, data-driven decision-making, and whole-person health outcomes.

Responsibilities

• Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions.
• Influence provider strategy by helping translate clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches.
• Help shape the organization’s clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships.
• Ensure the policies that orient company and providers to delivering patient health through policy design, policy execution, and policy compliance.
• Develop and govern dental clinical protocols, standards of care, and evidence-based guidelines.
• Ensure clinical policies reflect best practices, emerging science, and oral-systemic health principles.
• Chair or co-chair clinical policy governance forums and guide consensus-based clinical decision-making.
• Translate clinical policy into clear clinical intent that informs utilization management and quality programs.
• Enable continuous Clinical Quality Improvement – Advance Quality & Outcomes.
• Provide quality leadership focused on outcomes, effectiveness, variation reduction, and continuous improvement.
• Oversee clinical quality programs that monitor member outcomes, safety, and care appropriateness.
• Use data and analytics to identify opportunities to improve clinical performance, care efficiency, and member experience.
• Operate as a consensus builder who brings stakeholders together around shared clinical and quality objectives.
• Drive Strategy, Innovation & Transformation.

Qualifications

• 12+ years with Bachelor’s degree; 3+ years management.
• DDS or DMD required.
• Active, unrestricted dental license, or ability to obtain appropriate licensure if required.
• Minimum of 10 years of transformational leadership experience in dental, managed care, health plan, payer, or related healthcare environments.
• Significant experience in clinical quality, utilization management, clinical review, and clinical policy.
• Demonstrated experience in both direct clinical care and administrative leadership.
• Experience applying evidence-based practice, clinical research, or scientific literature to clinical policy, quality, or care model decisions.
• Prominent ability to influence senior leaders and work effectively across a complex, matrixed organization.
• Strong strategic thinking and ability to translate clinical expertise into business and operational impact.
• Senior-level leadership experience in clinical quality, clinical policy, utilization management, or related roles within a health plan, healthcare organization, or integrated care environment.
• Strong executive presence with the ability to influence, build consensus, and lead through change.
• Advanced knowledge of managed care principles.
• Verbal and written communication skills.
• Dental background and knowledge of dental managed care.
• Strong Organizational and retention skills.
• Must give strong attention to detail and ability to handle multiple concurrent tasks with constant interruptions.
• Successful presentation and negotiation skills.
• Able to maintain confidentiality.
• To coordinate activities over large service areas.
• Must demonstrate capability to interface & maintain effective relationships with all levels of management and business partners.
• Must demonstrate analytical & problem solving skills and experience at both a strategic and functional level.

Benefits

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.

About Us

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

Our 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.

Join Us

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, on Facebook and Instagram, Delta Dental Ins. on Twitter and Delta Dental Ins. on LinkedIn.