Dentist; Part-Time, Remote

Job Details:

Job Location:

All States (Remote) - OK, Position Type:
Part Time, Job Category:
Dental, Help Shape Better Oral Health Outcomes at Liberty Dental Plan

The Staff Dentist (Part-Time) is responsible for performing timely, accurate, and clinically sound reviews of dental claims and service requests. Working closely with providers, dental leadership, and cross-functional teams, you will support consistent coverage determinations, quality improvement initiatives, and exceptional member experiences.

• 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.

• 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.

• 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.

• Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicare & 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.

• DDS or DMD degree from an accredited dental school.
• Current, active, unrestricted dental license in good standing from any U.S. state or territory.
• Minimum of six (6) years of experience as a practicing dentist.
• 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.
• 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.
• Strong computer proficiency and the ability to quickly learn new technology platforms.
• Excellent written communication skills with the ability to develop clear and defensible clinical determinations.

• Prior experience reviewing dental claims, prior authorizations, utilization management cases, or clinical determinations within a payer, managed care, dental benefits, or health plan environment.
• Experience conducting peer-to-peer provider consultations.
• Experience supporting grievances, appeals, and secondary clinical reviews.
• Familiarity with clinical review platforms, claims adjudication systems, and AI-assisted review technology such as Overjet.
• Knowledge of NCQA and URAC utilization management standards.
• Experience training, mentoring, or calibrating clinical review teams.
• Project management or process improvement experience.

• 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…