About the Role
We are seeking an experienced Staff Dentist (1099 Independent Contractor) to support Utilization Management (UM) and Utilization Review (UR) functions across our dental plans. This is a fully remote, non-clinical, review-focused role ideal for dentists who want to apply their clinical expertise to drive quality, compliance, and appropriate care delivery at scale.
In this role, you will perform clinical reviews of claims, prior authorizations, and referrals across Commercial, Medicare Advantage, and Medicaid lines of business, helping ensure regulatory compliance, cost-effective care, and high-quality oral health outcomes.
Assignment Details
- Work Type: 100% Remote (U.S.-based)
- Contract Type: 1099 Independent Contractor
- Duration: 6-month assignment with potential for extension
- Schedule: Flexible, based on business needs
- Licensure: Active, unrestricted dental license in California or New Jersey is required; candidates without one of these state licenses will not be considered
Key Responsibilities
Utilization Management & Clinical Review
- Perform timely clinical adjudication of dental claims and prior authorization requests
- Determine medical necessity and benefit coverage using clinical expertise and plan guidelines
- Interpret radiographs, charts, and supporting documentation to inform decisions
- Identify inappropriate, unnecessary, or low-value services
Quality Management & Improvement
- Participate in quality improvement initiatives, audits, and utilization analyses
- Conduct focused chart reviews to identify utilization trends and potential quality concerns
- Support SIU activities, including provider site reviews and corrective recommendations
- Analyze treatment patterns and recommend improvements
Provider Engagement & Peer Review
- Conduct peer-to-peer consultations with network providers
- Participate in grievance, appeal, and secondary review processes
- Collaborate with specialists or subject-matter experts as needed
Collaboration, Training & Committees
- Participate in calibration sessions, trainings, and interrater reliability activities
- Attend clinical and operational meetings
- Contribute to credentialing and quality committees
- Support resolution of provider and member concerns
Tele-Dentistry & Clinical Support
- Provide clinical input during tele-dentistry consultations when needed
Regulatory & Subject Matter Expertise
- Maintain expertise in dental benefit plans and Medicaid program requirements
- Support regulatory reporting and compliance initiatives
Qualifications
- DDS or DMD from an accredited dental school
- Active, unrestricted dental license in good standing in a U.S. state
- Minimum:
- 4+ years practicing as a dentist
- 2+ years experience with claims review, utilization management, or payer-side dentistry preferred
- Strong knowledge of:
- Dental coding and clinical guidelines
- Managed care and reimbursement systems
- Medical necessity criteria and adjudication processes
- Ability to interpret radiographs and dental records
- Strong analytical, decision-making, and communication skills
- Current professional malpractice insurance required (must be maintained throughout the contract period)
Work Environment & Structure
- Fully remote, computer-based role
- Work is primarily sedentary and requires extended screen time
- Flexible scheduling aligned with business needs
- 1099 contractor position (no employee benefits)
What Makes You a Strong Fit
- You bring a clinical lens to business decisions, balancing quality, cost, and compliance
- You are detail-oriented and consistent in applying guidelines and policies
- You communicate effectively in peer-to-peer provider discussions
- You thrive in a collaborative, healthcare environment
Why Join
- Fully remote opportunity with flexible scheduling
- Apply your clinical expertise beyond the operatory
- Influence care quality and outcomes at a population level
- Work on meaningful, mission-driven initiatives
- Opportunity for contract extension based on performance and business needs
How to Apply
Submit your resume, licensure details, and proof of current malpractice insurance to be considered for this opportunity.
