Senior Dentist, Utilization Management; Remote) NY

Help Shape the Future of Oral Health Care as a Senior Staff Dentist

Are you an experienced dentist looking to expand your impact beyond clinical practice? Join LIBERTY Dental Plan as a Senior Staff Dentist and play a critical role in improving quality, supporting providers, and ensuring members receive clinically appropriate, evidence-based dental care across Commercial, Medicare Advantage, and Medicaid programs.

In this influential clinical leadership role, you’ll leverage your expertise to guide utilization management decisions, support quality improvement initiatives, mentor colleagues, and help drive better oral health outcomes on a broader scale.

The Senior Staff Dentist reports to an assigned State Dental Director and provides clinical leadership and oversight for Utilization Management (UM) and Utilization Review (UR) programs. This role ensures timely, accurate, and clinically appropriate adjudication of dental claims and prospective service requests, including referrals and prior authorizations.

The Senior Staff Dentist plays a key role in quality and compliance activities, provider engagement, peer review, staff calibration, and clinical mentorship. This position supports all lines of business, including Commercial, Medicare Advantage, and Medicaid, while maintaining a strong focus on regulatory compliance, quality outcomes, and financial stewardship.

• 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.

• DHS 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.
• Mini…