Staff Dentist (1099 Independent Contractor)
About The Position
We are seeking an experienced Staff Dentist (1099 Independent Contractor) to support Utilization Management (UM) and Utilization Review (UR) functions across our dental plans. This is a fully remote, non-clinical, review-focused role ideal for dentists who want to apply their clinical expertise to drive quality, compliance, and appropriate care delivery at scale. In this role, you will perform clinical reviews of claims, prior authorizations, and referrals across Commercial, Medicare Advantage, and Medicaid lines of business, helping ensure regulatory compliance, cost-effective care, and high-quality oral health outcomes.
Requirements
- DDS or DMD from an accredited dental school
- Active, unrestricted dental license in good standing in a U.S. state
- Minimum: 4+ years practicing as a dentist
- 2+ years experience with claims review, utilization management, or payer-side dentistry preferred
- Strong knowledge of: Dental coding and clinical guidelines, Managed care and reimbursement systems, Medical necessity criteria and adjudication processes
- Ability to interpret radiographs and dental records
- Strong analytical, decision-making, and communication skills
- Current professional malpractice insurance required (must be maintained throughout the contract period)
- Active, unrestricted dental license in California or New Jersey is required; candidates without one of these state licenses will not be considered
Nice To Haves
- Apply your clinical expertise beyond the operatory
- Influence care quality and outcomes at a population level
- Work on meaningful, mission-driven initiatives
- You bring a clinical lens to business decisions, balancing quality, cost, and compliance
- You are detail-oriented and consistent in applying guidelines and policies
- You communicate effectively in peer-to-peer provider discussions
- You thrive in a collaborative, healthcare environment
Responsibilities
- Perform timely clinical adjudication of dental claims and prior authorization requests
- Determine medical necessity and benefit coverage using clinical expertise and plan guidelines
- Interpret radiographs, charts, and supporting documentation to inform decisions
- Identify inappropriate, unnecessary, or low-value services
- Participate in quality improvement initiatives, audits, and utilization analyses
- Conduct focused chart reviews to identify utilization trends and potential quality concerns
- Support SIU activities, including provider site reviews and corrective recommendations
- Analyze treatment patterns and recommend improvements
- Conduct peer-to-peer consultations with network providers
- Participate in grievance, appeal, and secondary review processes
- Collaborate with specialists or subject-matter experts as needed
- Participate in calibration sessions, trainings, and interrater reliability activities
- Attend clinical and operational meetings
- Contribute to credentialing and quality committees
- Support resolution of provider and member concerns
- Provide clinical input during tele-dentistry consultations when needed
- Maintain expertise in dental benefit plans and Medicaid program requirements
- Support regulatory reporting and compliance initiatives
Benefits
- No employee benefits
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What This Job Offers
Career Level
Mid Level
