Remote Staff Dentist: Utilization Review Specialist

LIBERTY Dental Plan; Tustin (CA); Remote; USD 102,000 - 113,000; Part time

Benefits offered by this job

Remote work

401(k) retirement benefits

Employee Assistance Program

Generous vacation & sick leave

Paid company holidays

Job summary

LIBERTY Dental Plan is seeking a Staff Dentist for a fully remote, part-time role (20 hours per week). You will review dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace, Medicare Advantage, and Medicaid populations, applying clinical guidelines and medical necessity criteria to reach coverage determinations.

You will collaborate with dental leadership, participate in calibration and quality improvement, and stay current with ADA CDT updates and

Qualifications

• DDS or DMD degree from an accredited dental school.
• Active Nevada dental license in good standing.
• Experience reviewing dental claims, referrals, and prior authorizations is preferred.

Responsibilities

• Review dental claims, referrals, and prior authorization requests across multiple lines of business.
• Evaluate treatment plans, radiographs, and chart notes using clinical guidelines and medical necessity criteria.
• Make coverage determinations based on benefit plans and applicable policies.
• Meet productivity, quality, and turnaround-time standards.
• Document clinical rationale in line with regulatory and accreditation requirements.
• Participate in calibration sessions to ensure consistency in clinical decisions.
• Collaborate with leadership to address complex clinical scenarios.
• Consult with dental specialists as needed to support decisions.
• Support Medicaid program understanding and ADA CDT coding updates.
• Stay current with regulatory and accreditation requirements.

Skills

Communication skills

Dental knowledge

Radiograph interpretation

Compliance knowledge

Education

DDS or DMD from an accredited dental school

Tools

Overjet

Claims adjudication systems

Job description

LIBERTY Dental Plan is seeking a Staff Dentist for a fully remote, part-time role (20 hours per week). You will review dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace, Medicare Advantage, and Medicaid populations, applying clinical guidelines and medical necessity criteria to reach coverage determinations.

You will collaborate with dental leadership, participate in calibration and quality improvement, and stay current with ADA CDT updates and