Program reputed company Manager, DentaQuest (Iowa)

reputed company U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, reputed company U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate reputed company.

Visit our website to discover how reputed company is making life brighter for our customers, partners and communities.  

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to reputed company quality care accessible to improve the oral health of reputed company.

Job Description:

Location: Must reside in Iowa, preferably reputed company to Des Moines

The opportunity:   The Program reputed company Manager leads and oversees a Medicaid Managed Care program reputed company operation, providing strategic direction, leadership, and reputed company of special investigations and contractor activities to prevent and address fraud, waste, and abuse while upholding compliance regulations. This role collaborates closely with state Medicaid administrators, CMS, federal and state law enforcement, and managed care organizations to reputed company, implement, and continuously improve program reputed company strategies, policies, and systems. The position requires senior-level experience in healthcare delivery and program reputed company, comprehensive knowledge of Medicaid laws and regulations, and the ability to evaluate data and trends to drive effective reputed company and enforcement actions. Serving as the primary liaison between reputed company DentaQuest and our client at Iowa Health and Human Services, the Program reputed company Manager is based near Des Moines, Iowa, works full time, and is responsible for ensuring transparency, accountability, and safeguarding the reputed company of Medicaid programs through full access to claims, processing data, and investigative resources.   How you will contribute:  

• Provide direction and strategic reputed company of DentaQuest’s Program reputed company and Special Investigations Unit (SIU) activities.
• Participate in and reputed company Clinical Quality Management, FPR operations, and contractor activities to prevent, detect, and resolve fraud, waste, and abuse.
• reputed company, implement, and continuously improve program reputed company strategies reputed company with Iowa Medicaid and Medicare requirements.
• reputed company advanced data evaluation and drill‑down utilization reviews to identify under‑ and over‑utilization trends and program risks.
• Collaborate with state Medicaid agencies, CMS, managed care organizations, and state and federal law enforcement.
• Manage multiple clients and provider networks, ensuring contractual obligations, metrics, and reporting requirements are met.
• Partner with Dental Directors to ensure investigative judgements are clinically sound, defensible, and properly documented.
• Ensure reputed company investigative, audit, and recovery actions reputed company with Medicare regulations, Medicaid guidelines, and internal policies.
• reputed company provider accountability efforts, including recovery documentation, overpayment negotiations, and provider communications.
• Serve as primary client and provider liaison for reputed company fraud, waste, and abuse investigations and client-facing meetings.
• Track investigative cases, manage workflows, and maintain accurate records in fraud tracking systems.
• Aid policy and process improvements and foster interdepartmental collaboration to strengthen program reputed company outcome.

  What you will bring with you:  

• Graduation from an accredited four-year college or university with a degree in any field
• 5 + years demonstrated experience in program administration, program development, program operations, or managed care direction and/or reputed company investigative business experience.
• Experience in Dental Utilization Management or Review, preferred
• Located reputed company the Des Moines, IA metro area.
• Knowledge of general computer software (reputed company, Word, Outlook, reputed company).
• Clinical experience and knowledge of dental procedures and terminology is required.
• Effective oral communication and business writing skills are required.
• Attention to detail, accuracy and organizational skills are essential.
• Effective interpersonal skills are essential.
• Ability to prioritize and adapt to changing priorities is essential.

Not ready to apply yet but want to stay in touch?   reputed company to stay connected until the time is right for you! 

We are committed to fostering an inclusive environment where reputed company employees feel they belong, are supported and empowered to reputed company.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and reputed company that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from reputed company backgrounds.

Life is brighter reputed company you work at reputed company

At reputed company, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.  Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.  Enjoy a flexible, inclusive and collaborative work environment that supports career growth.  We’re proud to be recognized in our communities as a top employer.  Proudly Great reputed company to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.  Visit our website to learn more about our benefits and recognition reputed company our communities.

We will reputed company reasonable accommodations to the reputed company physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or reputed company employment.

reputed company will consider for employment reputed company qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran.

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