Dental Referral And Authorization Operations Supervisor

Dental Referral and Authorization Operations Supervisor

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The Dental Referral and Authorization Operations Supervisor is a working supervisor position with the majority of time spent directly on processing referrals and authorizations. The remaining time is divided between oversight of day-to-day referral and authorization operations, daily queue management, and people leadership of the Dental Referral and Authorization Specialist team. Operational oversight includes managing the overall referral and prior-authorization process and reporting, dental program communications, and ensuring regulatory compliance. The supervisor is accountable for team performance, including maintaining required quality and production standards, and implementing and evaluating new processes and procedures that support Dental program goals and objectives.

Estimated Hiring Range:

$72,765.00 - $88,935.00

Bonus Target:

Bonus - SIP Target, 5% Annual

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

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Essential Responsibilities

Operational Oversight

• Monitor daily referral queue volumes, determine and implement appropriate escalation actions as needed to ensure regulatory compliance and operational efficiency.
• Handle escalated phone calls and emails to provide problem resolution as needed.
• Work collaboratively with dental department roles to resolve referral and authorization issues and provide input as a subject matter expert for cross‑department issues for members and providers.
• Partner with care coordinators on complex referrals or high‑risk members.
• Monitor and report general and specialty provider access; identify, analyze, and escalate emerging barriers and trends to dental leadership.
• Support oral health promotion and escalation from across the organization.
• Serve as a subject matter expert and information resource for the team regarding referral and authorization functions, dental benefits, coverage, dental chart components, and provider access.
• Remove barriers for members and providers through improvements in the referral process.

Process Management & Quality Improvement

• Conduct interrater reliability assessments and additional quality audits to ensure accuracy, consistency, maintain compliance standards, and identify areas for improvement.
• Provide input and contribute to the development of relevant policies and procedures; lead the development, revision, and maintenance of resources such as process guides and documented workflows.
• Share voice‑of‑customer feedback (member, provider, etc.) with dental leadership to improve referral processes and quality.
• Participate in quality and organizational process improvement activities and teams as assigned.
• Contribute information and ideas toward work processes.
• Actively participate in team and department meetings.
• Participate in leadership and other work‑related continuing education when offered or directed.

Process Dental Referrals and Prior Authorizations (Majority of Overall Work Time)

• Perform the comprehensive and full scope of the Dental Referral and Authorization Specialist role, including processing referrals and pre-authorizations and generating denial letters.
• Maintain relationships with network partners and collaborate with internal departments to support coordinated referral and authorization workflows.

Employee Supervision

• Supervise team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with People and Culture as needed.

Experience and/or Education

• Required

• Minimum 5 years' experience in the dental industry, including experience with dental provider networks, dental coding, dental clinic operations, and/or scheduling

• Preferred

• Minimum 1 year experience in a supervisory, lead position or completion of CareOregon's Aspiring Leaders Program; lead roles preferably include regular assistance to a manager or supervisor in staff hiring, coaching, performance evaluation, and other supervisory tasks

• Experience with referral and authorization processes

• Experience in Medicaid environment

Knowledge, Skills and Abilities Required

Knowledge

• Advanced knowledge in one or more of the following areas:
• Commercial or Medicaid Dental benefits
• Dental terminology, dental charting, and dental coding
• Dental clinic operations

Skills and Abilities

• Advanced written and verbal communication skills that support clear and professional interactions
• Ability to coach, mentor, and serve as an effective resource for staff
• Ability to clearly articulate policies, procedures, goals, and expectations
• Ability to provide constructive feedback and share information effectively
• Exceptional interpersonal and organizational skills that foster collaboration across teams
• Excellent critical thinking and decision‑making skills
• Ability to effectively solve complex or unique problems and recognize when to escalate issues appropriately
• Ability to continually generate and implement ideas that improve quality, efficiency, and productivity
• Strong accountability and initiative in managing personal workload, priorities, and outcomes
• Advanced customer service skills with the ability to navigate sensitive or complex situations
• Ability to develop and maintain strong professional relationships with Primary Dental Providers (PDPs), specialists, and internal stakeholders
• Ability to work both independently and collaboratively with minimal supervision
• Advanced ability to work in a fast‑paced environment while managing multiple tasks and deadlines
• Expert ability to adhere to a set schedule and sustain excellent attendance.
• Ability to support and comply with organizational policies, procedures, and guidelines.
• Ability to accept direction and feedback, manage stress, and adapt to changing priorities.
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/d

Working Conditions

Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 1 day/week

Note: The in‑person office requirement is usually less than 4 days/month, though exceptions may occur

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.