Remote Staff Dentist — Claims Review & Utilization

Liberty Dental Plan, Inc.; Tustin, Northern (CA, KY); Hybrid; USD 150,000 - 165,000; Full time

Benefits offered by this job

401(k) retirement benefits

Dental coverage for employees

Vision insurance

Life and AD&D insurance

Flexible Spending Accounts

Wellness programs

Employee Assistance Program (EAP)

Paid holidays

Tuition reimbursement

Remote or hybrid work options

Job summary

Liberty Dental Plan, Inc. is hiring a Nevada/California licensed Staff Dentist for a fully remote role focused on utilization management and clinical reviews.

You will review dental claims, interpret records and radiographs, and ensure medical necessity while collaborating with Utilization Management, Claims, and Dental Directors teams. You will participate in calibration, maintain quality standards, and engage in provider consultations.

Qualifications

• DDS or DMD from an accredited institution.
• Active, unrestricted Nevada and California 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.

Responsibilities

• 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.

Skills

Clinical judgment

Interpret radiographs

Managed care knowledge

Written communication

High-volume review

AI-supported tools

Education

DDS or DMD

Tools

AI-supported platforms

Job description

Liberty Dental Plan, Inc. is hiring a Nevada/California licensed Staff Dentist for a fully remote role focused on utilization management and clinical reviews.

You will review dental claims, interpret records and radiographs, and ensure medical necessity while collaborating with Utilization Management, Claims, and Dental Directors teams. You will participate in calibration, maintain quality standards, and engage in provider consultations.