Make an Impact Beyond the Operatory. Help Shape Quality Dental Care for Thousands of Members.
Liberty Dental Plan is seeking an experienced Staff Dentist to join our Clinical Operations team. This is an exciting opportunity for a dentist who is passionate about evidence-based care, utilization management, and improving oral health outcomes on a broader scale. In this fully remote role, you will leverage your clinical expertise to support coverage determinations, provider engagement, and quality initiatives while ensuring members receive appropriate, high-quality dental care.
This position supports dental claims review operations for Oklahoma, Ohio, and West Virginia and plays a critical role in maintaining clinical consistency, regulatory compliance, and operational excellence across Medicaid, Medicare Advantage, Commercial, and Marketplace lines of business.
About the Role
The Staff Dentist supports Liberty Dental Plan's Utilization Management (UM) and Utilization Review (UR) programs through the timely, accurate review of dental claims, prior authorizations, referrals, appeals, and related clinical requests. This role collaborates closely with Dental Directors, clinical reviewers, providers, and operational teams to ensure coverage determinations are clinically sound, evidence-based, and aligned with benefit plan requirements.
The ideal candidate is a highly productive clinical reviewer who can efficiently manage large review volumes while consistently delivering accurate, well-supported determinations within established turnaround time requirements.
What You'll Do
Utilization Management & Clinical Review
- Review dental claims, prior authorization requests, referrals, and treatment plans across multiple lines of business.
- Analyze clinical documentation, radiographs, and supporting records to make accurate coverage determinations.
- Apply benefit plan provisions, medical necessity criteria, and evidence-based clinical guidelines during the review process.
- Document clear, thorough, and defensible clinical rationales for all determinations.
- Consistently meet productivity, accuracy, and turnaround-time expectations.
Clinical Consistency & Quality Improvement
- Participate in calibration sessions to promote consistency and accuracy across the clinical review team.
- Complete inter-rater reliability assessments and maintain established quality standards.
- Partner with leadership and peers to evaluate complex clinical scenarios and ensure consistent application of policies and guidelines.
- Incorporate feedback from quality audits and review activities to continuously improve performance.
Provider Collaboration & Appeals Support
- Conduct peer-to-peer consultations with treating providers regarding clinical determinations and treatment alternatives.
- Support grievance, appeal, and secondary review processes.
- Consult with specialists and subject matter experts when additional expertise is needed.
Training & Organizational Collaboration
- Participate in required clinical, regulatory, and operational training programs.
- Engage in departmental meetings and quality improvement initiatives.
- Collaborate with cross-functional teams to support organizational goals and member outcomes.
Regulatory & Subject Matter Expertise
- Maintain expertise in Medicaid, Medicare Advantage, and commercial dental benefit plans.
- Stay current on ADA CDT coding updates and evidence-based clinical guidelines.
- Support compliance with NCQA, URAC, federal, and state regulatory requirements.
What You'll Bring
Required Qualifications
- DDS or DMD degree from an accredited dental school.
- Current, active, unrestricted dental license in good standing from any U.S. state or territory.
- Ability to successfully complete Liberty Dental Plan credentialing requirements.
- Minimum of six (6) years of professional dental experience.
- Experience working with Medicaid and Medicare Advantage dental programs.
- Demonstrated ability to efficiently manage high-volume clinical review queues while maintaining exceptional accuracy, quality standards, and compliance with regulatory and internal turnaround time requirements.
- Strong knowledge of dental claims adjudication, medical necessity criteria, and utilization management principles.
- Demonstrated ability to interpret clinical records, treatment plans, and dental radiographs.
- Excellent written communication skills with the ability to develop clear and defensible clinical determinations.
Preferred Qualifications
- Prior experience reviewing dental claims, prior authorizations, utilization management cases, or clinical determinations within a payer, managed care, dental benefits, or health plan environment.
- Experience conducting peer-to-peer provider consultations.
- Experience supporting grievances, appeals, and secondary clinical reviews.
- Familiarity with clinical review platforms, claims adjudication systems, and AI-assisted review technology such as Overjet.
- Knowledge of NCQA and URAC utilization management standards.
- Experience training, mentoring, or calibrating clinical review teams.
- Project management or process improvement experience.
What Success Looks Like
- Consistently meets or exceeds productivity, quality, and turnaround-time benchmarks.
- Effectively manages high-volume claims and authorization review queues without sacrificing clinical accuracy.
- Produces clear, defensible clinical rationales that support sound coverage determinations.
- Collaborates effectively with providers, peers, and leadership to ensure consistent application of clinical guidelines and benefit policies.
Salary Range
$150,000 - $165,000 per year
Actual compensation may vary based on experience, qualifications, licensure, and other business considerations.
Why Join Liberty Dental Plan?
At Liberty Dental Plan, you'll have the opportunity to apply your clinical expertise in a role that influences care decisions for thousands of members. You'll work alongside experienced clinical leaders and contribute to evidence-based decision-making that improves access to quality oral healthcare while supporting providers and members across multiple markets.
If you're an experienced dentist with Medicaid and Medicare Advantage expertise who thrives in a collaborative, analytical environment and wants to make a meaningful impact beyond direct patient care, we encourage you to apply.
Work Location
- Fully Remote
- Supports clinical review operations for Oklahoma, Ohio, and West Virginia
- Candidates may reside anywhere within the United States
- Active, unrestricted dental license from any U.S. state or territory accepted
Ready to Make a Broader Impact?
Apply today and help Liberty Dental Plan deliver quality, affordable, and accessible dental care through clinical excellence and evidence-based decision-making.
