At Liberty Dental Plan, our mission is to improve oral health by delivering high-quality, accessible, and cost-effective dental benefits. We are seeking an experienced Staff Dentist to join our clinical team and play a critical role in supporting our Utilization Management (UM) and Utilization Review (UR) programs.
This fully remote opportunity offers a consistent 20-hour-per-week schedule, allowing experienced dentists to apply their clinical expertise in a collaborative managed care environment while helping improve access to high-quality oral healthcare. You will review dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace Exchange, Medicare Advantage, and Medicaid populations, helping ensure members receive appropriate, evidence-based care while supporting quality outcomes and regulatory compliance.
About the Role
The Staff Dentist is responsible for performing timely, accurate, and clinically sound reviews of dental claims and service requests. Working closely with providers, dental leadership, and cross-functional teams, you will support consistent coverage determinations, quality improvement initiatives, and exceptional member experiences.
Employment Type: Part-Time, Non-Exempt
Work Arrangement: Fully Remote
Schedule: 20 hours per week
Compensation: $74.00 - $82.00 per hour
What You'll Do
Utilization Management & Clinical Review
- Review dental claims, referrals, and prior authorization requests across multiple lines of business.
- Apply clinical expertise to evaluate treatment plans, radiographs, chart notes, and supporting documentation.
- Make coverage determinations based on benefit plans, clinical guidelines, medical necessity criteria, and applicable policies.
- Meet established productivity, quality, and turnaround-time standards.
- Document clinical rationale clearly and accurately in accordance with regulatory and accreditation requirements.
Clinical Quality & Consistency
- Participate in calibration sessions to promote consistency and accuracy in clinical decision-making.
- Complete inter-rater reliability assessments and support ongoing quality improvement efforts.
- Collaborate with leadership and peers to address complex clinical scenarios and interpretation questions.
- Incorporate audit findings and feedback to continuously enhance determination accuracy and documentation quality.
Provider Engagement & Peer Collaboration
- Conduct peer-to-peer consultations with treating providers regarding clinical determinations and treatment alternatives.
- Participate in grievance, appeal, and secondary review activities.
- Consult with dental specialists and subject matter experts as needed to support informed clinical decision-making.
Regulatory & Operational Support
- Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicaid programs.
- Support regulatory reporting and accreditation-related activities.
- Stay current with ADA CDT coding updates, evidence-based treatment guidelines, and state-specific requirements.
- Participate in required training programs, departmental meetings, and organizational initiatives.
What You'll Bring
Required Qualifications
- DDS or DMD degree from an accredited dental school.
- Current, active, and unrestricted California dental license in good standing.
- Minimum of six (6) years of experience as a practicing dentist.
- Ability to successfully complete Liberty Dental Plan credentialing and recredentialing requirements.
- Strong knowledge of dental procedures, clinical guidelines, coding standards, and medical necessity criteria.
- Ability to review and interpret dental radiographs, treatment plans, and chart documentation.
- Excellent written and verbal communication skills.
- Ability to manage review volumes efficiently while maintaining quality and compliance standards.
Preferred Qualifications
- Experience in dental claims review, utilization management, managed care, or payer environments.
- Experience training, coaching, or mentoring clinical peers.
- Familiarity with claims adjudication systems and clinical review platforms.
- Experience with AI-assisted review technologies such as Overjet or similar solutions.
- Exposure to project management and quality improvement initiatives.
Knowledge, Skills & Abilities
- Understanding of commercial, Medicare, Medicaid, and managed care dental programs.
- Knowledge of reimbursement methodologies, utilization management principles, and regulatory requirements.
- Ability to clearly communicate and support evidence-based clinical determinations.
- Strong computer proficiency and the ability to quickly learn new technology platforms.
- Ability to work effectively in a collaborative, team-oriented environment.
- Commitment to maintaining all required licensure and continuing education requirements.
Why Join Liberty Dental Plan?
- Make a meaningful impact on the oral health of diverse member populations.
- Apply your clinical expertise in a collaborative, mission-driven organization.
- Help drive quality, consistency, and innovation in dental utilization management.
- Work alongside experienced dental and healthcare professionals dedicated to improving access to care.
- Enjoy the flexibility of a fully remote position with a predictable 20-hour-per-week schedule and competitive hourly compensation.
Ready to Make an Impact?
If you are a licensed California dentist passionate about clinical excellence, evidence-based decision-making, and improving oral health outcomes, we encourage you to apply today and join Liberty Dental Plan's dedicated clinical team.
