Help Shape Better Oral Health Outcomes at Liberty Dental Plan
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 20-24 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 (Part-Time) 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 - 24 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 Medicare & 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, unrestricted dental license in good standing from any U.S. state or territory.
- Minimum of six (6) years of experience as a practicing dentist.
- 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.
- 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.
- Strong computer proficiency and the ability to quickly learn new technology platforms.
- 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.
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.
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.
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 - 24 hour-per-week schedule and competitive hourly compensation.
Ready to Make an Impact?
Apply today and help Liberty Dental Plan deliver quality, affordable, and accessible dental care through clinical excellence and evidence-based decision-making.
