Senior Director Clinical Quality and Policy

Overview 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 role is responsible for key clinical functions including Utilization Management, Clinical Review, and Clinical Quality, shaping the organization’s clinical positioning in the marketplace, and supporting integrated care models that connect oral health to whole-person health. The leader works as a peer executive across clinical, operational, and enterprise stakeholders to influence enterprise priorities, provider engagement, quality outcomes, and market differentiation. Responsibilities Provide strategic and operational oversight for Utilization Management, Clinical Review, and Clinical Quality functions. Influence provider strategy by translating clinical standards, policy expectations, and quality priorities into clear guidance and engagement approaches. Shape the organization’s clinical positioning in the marketplace through thought leadership, external credibility, provider engagement, and strategic partnerships. 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 translate policy into clear clinical intent for utilization management and quality programs. Advance continuous Clinical Quality Improvement—focus on outcomes, effectiveness, variation reduction, and continuous improvement. Oversee programs that monitor member outcomes, safety, and care appropriateness, using data and analytics to identify opportunities to improve performance, care efficiency, and member experience. Serve as a consensus builder for shared clinical and quality objectives. Drive strategy, innovation, and transformation by aligning dental clinical strategy with broader business goals (growth, integrated care) and contributing to medical-dental integration and whole-person care initiatives. Lead and develop teams across clinical policy, dental directors, utilization management clinical staff, and clinical quality oversight. Represent Delta Dental of California and affiliated companies with industry partners as a trusted clinical voice. Qualifications Minimum Qualifications 12+ years with Bachelor’s degree; 3+ years management Additional Experience DDS or DMD required Active, unrestricted dental license, or ability to obtain 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 Experience in both direct clinical care and administrative leadership Experience applying evidence-based practice, clinical research, or literature to 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 or healthcare organization Strong executive presence with the ability to influence, build consensus, and lead through change Knowledge, Skills, and 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 Attention to detail and ability to handle multiple concurrent tasks Presentation and negotiation skills Ability to maintain confidentiality Ability to coordinate activities over large service areas Ability to interface with all levels of management and business partners Analytical and problem-solving skills at both strategic and functional levels Compensation and 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. Pay may vary based on KSAs, related experience, education, and location. Pay Grade 27. $190,254.00 - $439,724.00. About Us and Compliance Delta Dental is an equal opportunity employer. This position requires a background check. Proof of eligibility to work in the United States must be provided if selected for hire. #J-18808-Ljbffr Delta Dental Ins.