Dental Policy & Quality Manager

Location: Remote within the United States; employees cannot be hired from U.S. territories or Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, or Maine.

Salary: $93,873–$118,755 USD target hiring range; maximum current salary of $132,327 USD.

Company

hirify.global is a nonprofit member association providing health and dental benefits to federal employees, retirees, military retirees, and their families.

What you will do

• Own the development, documentation, maintenance, and governance of dental coverage policies, benefit criteria, CDT code guidance, and the version-controlled policy library.
• Lead the audit and realignment of existing policies against CDT standards, plan provisions, clinical criteria, and vendor adjudication practices.
• Serve as the final dental policy and coding authority for vendors, OPM filings, benefit reviews, member escalations, audits, and regulatory inquiries.
• Oversee the clinical review vendor relationship, including contract performance, service levels, determination consistency, corrective actions, and renewal coordination.
• Coordinate BENEFEDS CDT reporting and collaborate with actuarial, compliance, legal, network, operations, data, and product stakeholders.
• Provide clinical guidance, education content, escalation support, and technical direction to internal staff, providers, members, and external reviewers.

Requirements

• Bachelor’s degree in Dental Hygiene, Health Administration, Health Informatics, or a related field; additional relevant experience may substitute for formal education.
• Dental clinical training, licensure, or certification such as RDH or DDS, or equivalent clinical depth from dental utilization management or policy practice.
• At least 10 years of progressive experience in dental benefits, dental policy, dental utilization management, or managed dental care, including at least 3 years in a lead or functional authority role.
• Deep expertise in dental benefit policy, CDT codes, ADA coding guidelines, clinical benefit criteria, and annual CDT updates.
• Experience developing dental coverage policies, overseeing TPAs or clinical review vendors, establishing policy governance, and supporting audits, compliance, appeals, or regulatory reviews.
• Strong written communication, analytical, cross-functional collaboration, project management, and Microsoft Office skills.

Nice to have

• Experience with BENEFEDS, FEDVIP, or OPM-regulated dental benefit programs.
• Experience creating member or provider education materials, presentations, webinars, or dental plan content.
• Familiarity with dental utilization patterns, post-payment audits, claims data analysis, policy management tools, content management systems, or SharePoint.

Culture & Benefits

• Remote work with a dedicated, interruption-free home workspace suitable for protecting PHI and HIPAA information.
• Non-cellular high-speed internet is required, with minimum speeds of 30 Mbps download and 5 Mbps upload and latency below 80 ms; hotspots, satellite, and wireless service are not allowed.
• Competitive pay, an incentive plan, and health, vision, and dental benefits effective on day one.
• 401(k) plan with dollar-for-dollar matching up to a 4% employee contribution plus a 6% annual company contribution.
• Paid time off, well-being programs, life and disability coverage, community enrichment time, and tuition assistance.