Senior Staff Dentist

About the Role

Dental Plan is seeking a highly experienced and collaborative Senior Staff Dentist to provide clinical leadership across our Utilization Management (UM) and Utilization Review (UR) programs. This role is ideal for a dentist with experience in the dental benefits (payer) environment who is passionate about improving care quality, ensuring compliance, and driving better health outcomes.

You will play a key role in reviewing claims and prior authorizations, partnering with providers, and supporting care delivery across Commercial, Medicare Advantage, and Medicaid populations—particularly within California Medicaid (Medi-Cal) programs.

What You’ll Do

Clinical Review & Utilization Management

• Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance
• Interpret dental records, radiographs, and benefit plans to make clinically sound coverage determinations
• Identify utilization trends, inappropriate services, and opportunities to improve care delivery
• Conduct retrospective reviews and influence provider behavior through engagement
• Perform secondary reviews, including grievances and appeals determinations

Quality & Compliance

• Participate in Quality Improvement and Performance Management initiatives (PPM, SIU)
• Conduct focused chart audits to identify utilization and care delivery patterns
• Contribute to quality committees and regulatory reporting
• Provide clinical expertise in resolving provider and member grievances

Provider Engagement & Collaboration

• Conduct peer-to-peer consultations with network providers
• Promote provider education and engagement to improve documentation and care quality
• Collaborate with specialists and internal teams on complex cases

Cross-Functional Partnership

• Work closely with Analytics, Utilization Management, Claims, Provider Relations, and G&A teams
• Partner with leadership on clinical initiatives, training, and operational improvements
• Participate in state oral health initiatives and internal programs

A Day in the Life

• ~30% peer-to-peer provider calls
• ~30% clinical reviews (DCM and HCA work)
• ~25% appeals and case reviews
• ~15% supporting clinical leadership and special projects

What You’ll Bring

Required Qualifications

• DDS or DMD degree
• Active, unrestricted California dental license required
• Must be in good standing and eligible for credentialing
• Minimum 6 years of experience as a practicing dentist
• Minimum 2 years of experience in utilization management, claims review, or quality initiatives
• Strong clinical judgment and ability to interpret dental radiographs and patient records

Preferred Qualifications

• Experience in the dental benefits or payer environment
• Familiarity with California Medicaid (Medi-Cal) programs
• Ability to obtain and maintain multi-state licensure (company-supported)
• Arizona license preferred
• Experience mentoring or training clinical peers

Key Skills

• Knowledge of managed care, reimbursement systems, and regulatory compliance
• Expertise in dental coding, clinical guidelines, and medical necessity criteria
• Strong communication and interpersonal skills for provider engagement
• Analytical mindset with the ability to identify trends and drive improvements
• Proficiency in Microsoft Office and ability to learn new systems

Why Join LIBERTY Dental Plan

• Make a meaningful impact on oral health outcomes across diverse populations
• Work remotely while collaborating with a mission-driven, cross-functional team
• Help shape clinical quality, compliance, and best practices in the dental payer space
• Engage directly with providers and influence care delivery at scale
• Receive support for additional state licensure and professional development

Interview Process

• Initial recruiter screening
• 45-minute interview with Hiring Manager
• Final selection following candidate review

Apply Today

If you’re a clinically experienced dentist with strong judgment and payer experience—and you want to influence care at scale—we encourage you to apply and join LIBERTY Dental Plan.