Staff Dentist (Part-Time, Remote, California License)
About The Position
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. 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.
Requirements
- 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.
- 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.
Nice To Haves
- 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.
Responsibilities
- 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.
- 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.
- 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.
- 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.
Benefits
- Competitive pay structure and savings options to help you reach your financial goals.
- Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
- Employee Assistance Program (EAP) to support mental health and well-being.
- Generous vacation and sick leave policies, with the ability to roll over unused time.
- Paid company holidays.
- Remote or hybrid work options available for various positions.
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What This Job Offers
Job Type
Part-time
Career Level
Senior
