Staff Dentist (Part-Time, Remote, Nevada ​/California License

Job Details

Location:

Englishtown, NJ (fully remote). Position Type:
Part Time (20 hours per week). Compensation: $74.00–$82.00 per hour.

Liberty Dental Plan seeks an experienced Staff Dentist to support our Utilization Management (UM) and Utilization Review (UR) programs. The role involves reviewing dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace Exchange, Medicare Advantage, and Medicaid populations, ensuring evidence‑based access to care while supporting quality outcomes and regulatory compliance.

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 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.

Required Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted New Jersey 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.

Preferred Qualifications

• 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.

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.

• 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…