The Ryan White Dental Program (RWDP) is a comprehensive dental access program for persons living with HIV/AIDS in Massachusetts and Southern New Hampshire, funded under Ryan White Part A and with funds from the Massachusetts Department of Public Health. Services funded are recruitment of dentists and preventive, diagnostic and therapeutic services rendered by licensed dentists and dental hygienists.
Under the supervision of the Director of the Ryan White Dental Program, the Clinical/Quality Management Program Manager of RWDP will be responsible for clinical quality improvement, reviewing eligibility for clients accessing services; providing technical and monitoring assistance to assure dental vendors attain contracted goals & objectives; monthly reporting of program activities; maintaining consistent contact with dental providers and other parties as needed; and working collaboratively with program & fiscal staff to ensure system accountability.
Responsibilities
* Review dental treatment plans and history to determine appropriate options for people living with HIV (PLWH) seeking dental care to be reimbursed by the program
* Provide initial review of dental claims, including client eligibility, dental billing codes, and prior approvals
* Review past billing and client dental records to prevent duplicate or improper billing for services
* Monitor monthly prior approval expenditures and assist in reconciliation of payments in coordination with other Dental and BPHC fiscal staff
* With the assistance of other RWDP staff, review and update annual Scope of Services documents for dental contracts, including client eligibility, fee schedules, and other requirements
* With the assistance of other RWDP staff, develop and update a Standard Operating Procedures (SOP) manual, including policies and procedures for Dental staff, vendors, and clients; the client enrollment process; recruitment of vendors; and reimbursement process for dental services.
* Draft and revise quality management plan for the program, including tracking of health and quality of life indicators, dental standards of care, and quality improvement activities
* Conduct regular research into the most current dental best practices and disseminate such content to a diverse audience, including HIV service providers and clients
* Provide support on presentations to both internal and external stakeholders on the impact of services on the oral health care needs of PLWH
* Regularly attend programmatic meetings
* Handle communication with clients, dental providers, and others
* Perform other duties as required
* Master's degree in Public Health, Health Policy Administration, or a related discipline, such as sociology, organizational psychology, public health nursing, or health communications required plus 2 years of relevant experience; OR Bachelor's degree plus 2 years of equivalent experience in dental or other healthcare setting. 10 years of experience may be substituted for the degree requirement.
* Experience with and knowledge of community agencies and/or dental providers.
* Knowledge of public health, and epidemiological, outreach and educational models related to HIV and related diseases
* Demonstrated ability to establish effective communication and working relationships with vendors.
* Ability to write clear, concise reports, & to follow & give written and oral instructions in a precise, understandable manner.
* Advanced knowledge & experience with excel, MSOffice and knowledge of data analysis and epidemiology.
* Ability and experience working with diverse populations.
* Bilingual, bicultural a plus
* Knowledge of dental codes and procedures is preferred