Senior Director Clinical Quality and Policy

JOB DESCRIPTION

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.

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 policies that orient the company and providers to delivery patient health through policy design, execution and compliance. Develop and govern dental clinical protocols, standards of care, and evidence-based guidelines. Chair or co‑chair clinical policy governance forums and guide consensus-based clinical decision‑making. 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. Drive strategy, innovation and transformation. 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. Represent Delta Dental of California and affiliated companies when working with industry representatives.

QUALIFICATIONS

Minimum Qualifications 12+ years with a Bachelor's degree; 3+ years management experience. 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. 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, 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.

ADDITIONAL INFORMATION

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. Fair Chance Ordinances and Criminal Background Considerations This position requires that the applicant undergo a background check. Qualified applicants with arrest or conviction records will be considered for employment in accordance with any applicable federal, state or local laws, including, but not limited to, the California Fair Chance Act, the Los Angeles County Fair Chance Ordinance, the City of Los Angeles Fair Chance Initiative for Hiring Ordinance, the San Francisco Fair Chance Ordinance, and/or New York Corrections Law Article 23-A. #LI-Hybrid Equal Employment Opportunity Statement Delta Dental Ins. is an equal opportunity employer and is committed to providing a professional work environment free from discrimination and harassment. Individuals seeking employment at Delta Dental are considered without regard to race, ethnicity, color, age, sex, religion, national origin, ancestry, pregnancy, sexual orientation, gender identity, gender expression, genetic information, actual or perceived physical or mental disability, registered domestic partner status, caregiver status, marital status, veteran or military status, citizenship status, or any other legally protected category. Delta Dental is committed to providing equal employment opportunities to all employees and applicants for employment. Accordingly, we have adopted and maintain an Equal Employment Opportunity Policy, Harassment‑Free Work Environment Policy, and Respectful Workplace policies and will not tolerate violations of these policies. Unfortunately, our Delta Dental Enterprise is unable to hire individuals residing in Alaska, North Dakota, Nebraska, Hawaii, Oklahoma, Vermont, Maine, West Virginia, New Hampshire, Wyoming, Puerto Rico, District of Columbia (Washington D.C.) or other US Territories at this time. Proof of eligibility to work in the United States must be provided if selected for hire. #J-18808-Ljbffr Delta Dental of California