Expert Clinical Policy Advisor

@ Delta Dental Ins.

Overview

The Expert Clinical Policy Advisor develops, implements, coordinates, and collaborates with internal stakeholders on clinical and operational dental policies that support benefit design, claims processing, and provider engagement. This role ensures that all policies are evidence-based, comply with regulatory and accreditation standards, and align with organizational and industry requirements.

Responsibilities

• Develop and maintain clinical dental policies and guidelines based on current evidence and industry standards.
• Evaluate and improve existing clinical policies and procedures for efficiency and alignment.
• Lead or contribute to clinical committees and policy review groups for continuous improvement.
• Support the Clinical Policy Oversight Committee and ensure dental alignment across consultants.
• Coordinate review of policy documents to meet regulatory and organizational requirements.
• Act as SME for dental policy matters, provide training and policy updates.
• Support audits by providing documentation and rationale for policy decisions.
• Oversee policy documentation, training materials, change management, and transparency efforts.
• Review and update Utilization Management sections in relevant handbooks annually.
• Collaborate with internal stakeholders on issue resolution and process improvement projects.
• Support dental care case studies for internal education and performance consulting.

Qualifications

A Bachelor’s degree with a minimum of 4 years' experience in dental policy administration, and a DDS or DMD required. Candidates must possess excellent organizational, communication, and leadership skills, with strong critical thinking and problem-solving capabilities. Knowledge in dental policy administration, HIPAA compliance, CDT codes, and health care industry issues is essential.

Licenses & Base Pay

Required licenses include DDS or DMD upon hire. The national base pay range is estimated between $92,500 and $200,400.

Additional Information

Delta Dental Ins. offers competitive pay, comprehensive benefits, and a supportive work environment dedicated to growth, innovation and holistic wellbeing. The company champions equal employment opportunities and maintains a fair, respectful, and inclusive workplace.

Key skills/competency

• Dental policies
• Utilization management
• Regulatory compliance
• Clinical guidelines
• Policy development
• Stakeholder collaboration
• Evidence-based practice
• Audit and documentation
• Internal training
• Process improvement