Senior Staff Dentist, Utilization Management (Remote) NY

LIBERTY DENTAL PLAN CORPORATION•, NY

70d•$175,000 - $185,000•Remote

About The Position

LIBERTY Dental Plan is seeking an experienced dentist to join their team as a Senior Staff Dentist. This role focuses on improving quality, supporting providers, and ensuring members receive appropriate dental care across Commercial, Medicare Advantage, and Medicaid programs. The Senior Staff Dentist will provide clinical leadership for utilization management decisions, quality improvement initiatives, and mentorship. The position reports to an assigned State Dental Director and is responsible for the timely and accurate adjudication of dental claims and prospective service requests. This role supports all lines of business while focusing on regulatory compliance, quality outcomes, and financial stewardship.

Requirements

DDS or DMD degree from an accredited dental school.
Current, active, and unrestricted dental license in good standing.
Ability to successfully obtain and maintain credentialing and recredentialing with LIBERTY Dental Plan.
Minimum of 6 years of experience as a practicing dentist.
Minimum of 2 years of experience in quality initiatives, utilization management, claims review, prior authorization review, or related clinical review activities.
Previous experience working with Medicaid dental programs is required.
Demonstrated experience reviewing dental claims, treatment plans, clinical documentation, and coverage determinations within a managed care or payer environment.
Intermediate to advanced computer proficiency required, including Microsoft Office Suite and the ability to effectively utilize multiple business and clinical applications.

Nice To Haves

Proficiency with New York Medicaid dental programs, benefits, regulations, policies, and clinical review requirements.
Prior experience training, mentoring, or coaching peers.
Experience supporting provider engagement initiatives, quality improvement programs, and clinical calibration activities.
Experience working with Commercial and Medicare Advantage dental plans.
Demonstrated success managing oral healthcare costs and utilization management initiatives.
In-depth knowledge of commercial and managed care delivery systems, reimbursement methodologies, and quality improvement programs.
Expertise in dental procedure coding, claims adjudication, and medical necessity guidelines.
Ability to review and interpret dental records, charts, treatment plans, and radiographs.
Strong analytical, communication, and provider engagement skills.
Intermediate to advanced proficiency with Microsoft Office Suite, including Outlook, Word, Excel, PowerPoint, and Teams.
Advanced general computer skills preferred, including experience working within claims processing systems, utilization management platforms, electronic health records, workflow management systems, and reporting tools.
Project management experience and the ability to successfully create and implement plans.
Ability to work collaboratively across clinical and operational teams while providing leadership and guidance.
Ability to quickly learn and effectively utilize new systems and technology.
Ability to apply alternate benefits where appropriate and consistent with plan guidelines and accepted professional standards.
Commitment to maintaining continuing education requirements and professional licensure.

Responsibilities

Perform clinical reviews of dental claims and prior authorization requests across all lines of business to ensure compliance with contractual and regulatory turnaround time requirements.
Apply clinical judgment to interpret dental records, radiographs, treatment plans, and benefit structures to make appropriate coverage determinations.
Identify potentially unnecessary services, inappropriate care settings, and emerging utilization trends.
Participate in retrospective utilization management reviews, analyze utilization patterns, engage providers, and support behavioral changes that align with accepted clinical practices.
Conduct secondary reviews, including grievance and appeal determinations.
Participate in Quality Management and Performance Improvement activities.
Support Provider Performance Management (PPM) and Special Investigations Unit (SIU) initiatives, including provider site reviews, utilization analysis, and provider counseling activities.
Conduct focused and targeted dental chart audits to identify unusual utilization or care delivery patterns.
Participate in Quality Improvement Committees and provide clinical expertise in the resolution of member and provider grievances.
Collect, evaluate, and analyze data related to grievance, peer review, public policy, and credentialing activities.
Support regulatory, compliance, and quality reporting requirements.
Conduct peer-to-peer consultations with providers regarding utilization trends, quality concerns, and claims decisions.
Support provider engagement initiatives focused on improving care quality, documentation, and compliance.
Collaborate with dental specialists and subject matter experts to support complex clinical decision-making.
Mentor staff dentists as appropriate and support clinical development initiatives.
Lead and participate in calibration activities to ensure consistency and accuracy in clinical reviews.
Attend meetings with clinical and administrative leadership to discuss departmental operations, clinical findings, and training needs.
Participate in state oral health programs and organizational initiatives.
Develop and maintain expertise in LIBERTY Dental Plan products, benefits, and applicable Medicaid programs.
Provide clinical guidance and support to Utilization Management and Claims teams.
Perform occasional onsite chart reviews when required.

Benefits

Competitive pay structure and savings options
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice
Affordable medical insurance, with low-cost premiums for employee-only coverage
100% employer-paid dental coverage for employees and eligible dependents
Vision insurance with low-cost premiums for employee-only coverage and dependents
Company-paid basic life and AD&D insurance, with options to purchase additional supplemental coverage
Flexible Spending Accounts for healthcare and dependent care expenses
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance
Long-term disability coverage
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts
Employee Assistance Program (EAP)
Generous vacation and sick leave policies, with the ability to roll over unused time
10 paid company holidays
Tuition reimbursement for eligible educational expenses
Remote or hybrid work options available