Senior Director Clinical Quality and Policy

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. This leader will be accountable for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, while also helping shape the organization's broader clinical positioning in the marketplace and supporting the development of integrated care models that connect oral health to whole person health. The Senior Director brings strong clinical credibility, policy expertise, business acumen, and strategic leadership to help influence enterprise priorities, provider engagement, quality outcomes, and market differentiation. This leader moves confidently between strategy and execution while bringing the credibility to engage with providers and clinical leaders, the business acumen to influence enterprise decisions, and the vision to help position the organization more broadly in the marketplace as a trusted health plan focused on quality, whole person care, and improved outcomes This role operates as a peer executive leader and consensus builder across clinical, operational, and enterprise stakeholders.

Minimum Qualifications
 

• 12+ years w/Bachelor’s degree; 3+ years management 
   

Additional Experience
 

• 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 
•  Proven 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.

Knowledge, Skills, Abilities
 

• 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 gave strong attention to detail and ability to handle multiple concurrent tasks with constant interruptions
• Successful presentation and negotiation skills
• Ability to maintain confidentiality
• Ability to coordinate activities over large service areas
• Demonstrated capability to interface & maintain effective relationships with all levels of management and business partners
• Demonstrated analytical & problem solving skills and experience at both a strategic and functional level

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. 
Pay Grade 27. $190,254.00 - $439,724.00

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.

Ensures the policies that orients company and providers to delivery 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.

Enables 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 Help shape the organization’s clinical positioning in the marketplace by contributing to thought leadership, external credibility, provider engagement, and strategic partnerships. Align dental clinical strategy with broader business goals, including growth, innovation, and integrated care. Contribute to initiatives focused on medical-dental integration, oral-systemic health, and whole-person care.

Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight. Serve as a trusted clinical voice for internal stakeholders and external partners. Represents Delta Dental of California and affiliated companies when working with industry representatives