Senior Dental Utilization Leader — Remote & Impact

LIBERTY Dental Plan; New York (NY); Hybrid; USD 175,000 - 185,000; Full time

Benefits offered by this job

401(k) matching program

Medical insurance

Vision insurance

Dental coverage for dependents

Paid time off and holidays

Tuition reimbursement

Remote or hybrid work options

Job summary

LIBERTY Dental Plan is seeking a Senior Staff Dentist to lead utilization management and clinical review across Commercial, Medicare Advantage, and Medicaid programs. You will adjudicate dental claims, prior authorizations, and referrals while guiding quality and compliance initiatives.

The role emphasizes provider engagement, peer review, and calibration of clinical reviews. A DDS/DMD and NY Medicaid familiarity are highly valued.

Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted dental license in good standing.
• Minimum of 6 years of experience as a practicing dentist.
• Minimum of 2 years of experience in quality initiatives, utilization management, claims review, or related clinical review activities.
• Previous experience with Medicaid dental programs is required.
• Experience reviewing dental claims, treatment plans, and coverage determinations within a managed care or payer environment.

Responsibilities

• Perform clinical reviews of dental claims and prior authorization requests to ensure compliance and timely turnaround.
• Apply clinical judgment to interpret records, radiographs, treatment plans, and benefit structures for coverage determinations.
• Identify unnecessary services and emerging utilization trends.
• Conduct retrospective reviews and participate in grievance and appeal determinations.
• Support Quality Management and Performance Improvement activities.
• Mentor staff dentists and calibrate reviewers to ensure consistency in decisions.

Skills

Quality initiative experience

Utilization management

Claims review

Prior authorization review

Provider engagement

Education

DDS or DMD degree

Active dental license

Credentialing/recredentialing

Tools

Microsoft Office Suite

EHRs

Claims processing systems

Utilization management platforms

Job description

LIBERTY Dental Plan is seeking a Senior Staff Dentist to lead utilization management and clinical review across Commercial, Medicare Advantage, and Medicaid programs. You will adjudicate dental claims, prior authorizations, and referrals while guiding quality and compliance initiatives.

The role emphasizes provider engagement, peer review, and calibration of clinical reviews. A DDS/DMD and NY Medicaid familiarity are highly valued.