About the Role
Dental Plan is seeking an experienced and clinically driven Senior Staff Dentist to join our Clinical Affairs team. In this leadership role, you will help ensure the delivery of high-quality, cost-effective dental care by providing clinical oversight of utilization management and claims review processes.
This position offers the opportunity to influence care quality and provider engagement across Commercial, Medicare Advantage, and Medicaid programs while contributing to meaningful oral health initiatives. You’ll collaborate with cross-functional teams and serve as a mentor and clinical resource to support consistent, evidence-based decision-making across the organization.
** This role requires an Active, unrestricted New Jersey dental license in good standing **
What You’ll Do
Clinical Review & Utilization Management
- Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations
- Interpret dental records, radiographs, and benefit structures to assess medical necessity and coverage decisions
- Identify inappropriate utilization patterns and recommend improvements to align with best practices
- Conduct retrospective utilization reviews and support provider behavior change initiatives
- Complete appeal, grievance, and secondary review determinations
Quality, Compliance & Improvement
- Participate in quality management and performance improvement programs, including audits and provider performance initiatives
- Conduct chart reviews to identify trends in care delivery and utilization
- Support grievance resolution and contribute to regulatory reporting and compliance activities
- Provide clinical insight during committee reviews and quality improvement efforts
Provider Engagement & Peer Collaboration
- Lead peer-to-peer consultations with providers to discuss clinical decisions, utilization trends, and quality concerns
- Support provider education around compliance, documentation, and care standards
- Partner with specialists and subject matter experts on complex clinical cases
Leadership & Organizational Impact
- Mentor staff dentists and support clinical calibration efforts to ensure consistency across reviews
- Provide guidance to utilization management and claims teams
- Collaborate with Analytics, Claims, UM, and outreach teams to improve operational outcomes
- Participate in state oral health initiatives and organizational programs
A Day in the Life
In this role, your day is a blend of clinical review, collaboration, and quality improvement work:
- ~75% reviewing dental claims and utilization requests to ensure accuracy, compliance, and appropriate care decisions
- ~10% supporting quality initiatives, including investigating clinical trends and addressing care concerns
- ~5% handling expedited reviews with quick turnaround times to support members and providers
- ~5% participating in care management or interdisciplinary coordination efforts
- ~5% engaging in team collaboration, provider discussions, and other organizational priorities
You’ll regularly partner with teams across Analytics, Utilization Management, Claims, and Provider Outreach, while also connecting directly with network dentists through peer-to-peer consultations.
What You’ll Bring
Required Qualifications
- DDS or DMD from an accredited institution
- Active, unrestricted New Jersey dental license in good standing (required)
- Ability to obtain additional state licenses as needed (company-supported)
- Minimum 6 years of experience as a practicing dentist
- At least 2 years of experience in utilization management, claims review, or quality improvement initiatives
Preferred Qualifications
- Experience in the dental benefits or managed care industry
- Experience mentoring or training peers
- Multi-state licensure
- Familiarity with Medicaid programs
Key Skills & Expertise
- Strong clinical judgment and knowledge of dental procedures, coding, and adjudication guidelines
- Ability to interpret radiographs and dental records
- Knowledge of managed care systems, reimbursement models, and regulatory requirements
- Experience identifying fraud, waste, and abuse trends
- Strong collaboration, communication, and provider engagement skills
- Proficiency with Microsoft Office and ability to learn new systems quickly
Work Environment & Impact
- Remote role with collaboration across national teams
- High-impact role shaping clinical standards and improving member outcomes
Compensation
- Salary Range: $175,000 – $185,000 annually
(Final compensation will depend on experience, qualifications, and licensure.)
Why Join LIBERTY Dental Plan?
At LIBERTY, you’ll be part of a mission-driven organization dedicated to improving oral health outcomes through quality, innovation, and collaboration. This role allows you to leverage your clinical expertise beyond traditional practice—impacting care delivery at scale while working alongside a passionate and supportive team.
Ready to Make an Impact?
If you are a clinically strong, collaborative dentist with an active New Jersey license and a passion for improving care quality, we encourage you to apply today.
