Dentist

Make an Impact Beyond the Operatory. Help Shape Quality Dental Care for Thousands of Members.

Liberty Dental Plan is seeking an experienced Staff Dentist to join our Clinical Operations team. This is an exciting opportunity for a dentist who is passionate about evidence-based care, utilization management, and improving oral health outcomes on a broader scale. In this fully remote role, you will leverage your clinical expertise to support coverage determinations, provider engagement, and quality initiatives while ensuring members receive appropriate, high-quality dental care.

This position supports dental claims review operations for Oklahoma, Ohio, and West Virginia and plays a critical role in maintaining clinical consistency, regulatory compliance, and operational excellence across Medicaid, Medicare Advantage, Commercial, and Marketplace lines of business.

The Staff Dentist supports Liberty Dental Plan's Utilization Management (UM) and Utilization Review (UR) programs through the timely, accurate review of dental claims, prior authorizations, referrals, appeals, and related clinical requests. This role collaborates closely with Dental Directors, clinical reviewers, providers, and operational teams to ensure coverage determinations are clinically sound, evidence-based, and aligned with benefit plan requirements.

The ideal candidate is a highly productive clinical reviewer who can efficiently manage large review volumes while consistently delivering accurate, well-supported determinations within established turnaround time requirements.

• Review dental claims, prior authorization requests, referrals, and treatment plans across multiple lines of business.
• Analyze clinical documentation, radiographs, and supporting records to make accurate coverage determinations.
• Apply benefit plan provisions, medical necessity criteria, and evidence-based clinical guidelines during the review process.
• Document clear, thorough, and defensible clinical rationales for all determinations.
• Consistently meet productivity, accuracy, and turnaround-time expectations.

• Participate in calibration sessions to promote consistency and accuracy across the clinical review team.
• Complete inter-rater reliability assessments and maintain established quality standards.
• Partner with leadership and peers to evaluate complex clinical scenarios and ensure consistent application of policies and guidelines.
• Incorporate feedback from quality audits and review activities to continuously improve performance.

• Conduct peer-to-peer consultations with treating providers regarding clinical determinations and treatment alternatives.
• Support grievance, appeal, and secondary review processes.
• Consult with specialists and subject matter experts when additional expertise is needed.

• Participate in required clinical, regulatory, and operational training programs.
• Engage in departmental meetings and quality improvement initiatives.
• Collaborate with cross-functional teams to support organizational goals and member outcomes.

• Maintain expertise in Medicaid, Medicare Advantage, and commercial dental benefit plans.
• Stay current on ADA CDT coding updates and evidence-based clinical guidelines.
• Support compliance with NCQA, URAC, federal, and state regulatory requirements.

• DDS or DMD degree from an accredited dental school.
• Current, active, unrestricted dental license in good standing from any U.S. state or territory.
• Ability to successfully complete Liberty Dental Plan credentialing requirements.
• Minimum of six (6) years of professional dental experience.
• Experience working with Medicaid and Medicare Advantage dental programs.
• Demonstrated ability to efficiently manage high-volume clinical review queues while maintaining exceptional accuracy, quality standards, and compliance with regulatory and internal turnaround time requirements.
• Strong knowledge of dental claims adjudication, medical necessity criteria, and utilization management principles.
• Demonstrated ability to interpret clinical records, treatment plans, and dental radiographs.
• Excellent written communication skills with the ability to develop clear and defensible clinical determinations.

• Prior experience reviewing dental claims, prior authorizations, utilization…