Dentist

Job Details

Job Location:

New York - NY

Position Type:
Full Time

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!

Ready to take your clinical expertise beyond the traditional practice setting? At LIBERTY Dental Plan, our Staff Dentists play a critical role in shaping how quality dental care is delivered at scale.

In this fully remote position, you’ll use your clinical judgment to review claims and prior authorizations, helping ensure members receive the right care at the right time. Your work directly influences patient outcomes, supports providers, and strengthens the integrity of dental benefits across Commercial, Marketplace, Medicare Advantage, and Medicaid programs.

This is more than a review role—it’s an opportunity to collaborate with experienced clinical leaders, contribute to meaningful quality initiatives, and grow your impact within a mission-driven organization dedicated to improving oral health nationwide.

• Review dental claims and prior authorization requests, applying coverage guidelines and benefit plan policies to ensure accurate determinations
• Interpret dental records, radiographs, and clinical documentation to assess medical necessity
• Meet established productivity and quality benchmarks for clinical reviews
• Document clear, concise clinical rationale aligned with regulatory and accreditation standards

• Participate in calibration sessions to ensure consistent application of clinical guidelines and policies
• Complete interrater reliability assessments and meet accuracy benchmarks
• Raise complex or unclear cases for peer discussion and resolution
• Incorporate feedback from audits and reviews to continuously improve accuracy

• Conduct peer-to-peer consultations with providers regarding clinical decisions and treatment alternatives
• Support grievance and appeal reviews with clinical insight
• Collaborate with dental specialists and internal teams on complex cases

• Participate in clinical trainings and team meetings
• Partner with Utilization Management, Claims, Dental Directors, and Grievances & Appeals teams
• Support regulatory reporting and maintain knowledge of applicable standards and guidelines
• Stay current on ADA coding updates and evidence-based clinical practices

• ~90% of your time reviewing prior authorizations and dental claims using internal systems (including AI-supported platforms)
• Interpreting clinical documentation and applying your judgment to ensure accurate, compliant determinations
• ~10% of your time participating in calibration sessions, identifying trends (including fraud, waste, and abuse), and supporting workflow improvements

You’ll start your day by logging in, reviewing assigned cases, and managing your review queue while maintaining quality and turnaround expectations. You’ll also engage with colleagues and providers as needed to support accurate and consistent outcomes.

• DDS or DMD from an accredited institution
• Active, unrestricted New York dental license in good standing (required)
• Minimum 6 years of experience as a practicing dentist
• Experience with claims review, utilization management, or quality initiatives preferred

• Strong clinical judgment and ability to evaluate dental necessity and treatment appropriateness
• Ability to interpret dental radiographs and clinical records
• Knowledge of managed care systems, reimbursement models, and regulatory requirements
• Strong written communication skills to document clear and defensible clinical decisions
• Ability to manage high-volume review work efficiently while maintaining accuracy
• Comfort working in a remote, structured environment during standard business hours
• Proficiency with computer systems and ability to learn new technology platforms, including AI-supported tools

• Fully remote position
• Structur…