Senior Dentist, Utilization & Quality Lead

Santa Barbara Cottage Hospital; United States; Remote; USD 175,000 - 185,000; Full time

Benefits offered by this job

Competitive pay structure

401(k) retirement benefits

Dental coverage

Vision insurance

Life insurance

Remote or hybrid work options

Tuition reimbursement

Paid time off

Job summary

Liberty Dental Plan in the United States is seeking a Senior Staff Dentist to lead utilization management and clinical review, mentor staff, and support quality initiatives across Commercial, Medicare Advantage, and Medicaid programs.

The role reports to a State Dental Director and ensures timely, accurate coverage determinations while upholding regulatory compliance, quality outcomes, and financial stewardship.

Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted dental license.
• Ability to successfully obtain and maintain credentialing and recredentialing with LIBERTY Dental Plan.
• Minimum of 6 years of experience as a practicing dentist.
• Minimum of 2 years of experience in quality initiatives, utilization management, claims review, prior authorization review, or related clinical review activities.
• Previous experience working with Medicaid dental programs is required.
• Intermediate to advanced computer proficiency, including Microsoft Office Suite and multiple business/clinical apps.

Responsibilities

• Perform clinical reviews of dental claims and prior authorization requests across all lines of business to ensure compliance with contractual and regulatory turnaround time requirements.
• Apply clinical judgment to interpret dental records, radiographs, treatment plans, and benefit structures to make appropriate coverage determinations.
• Identify potentially unnecessary services, inappropriate care settings, and emerging utilization trends.
• Participate in retrospective utilization management reviews, analyze utilization patterns, engage providers, and support behavioral changes that align with accepted clinical practices.
• Conduct secondary reviews, including grievance and appeal determinations.

Skills

Clinical leadership

Utilization management

Claims review

Peer review

Provider engagement

Data analysis

Microsoft Office

Education

DDS or DMD degree

Active dental license

Tools

Microsoft Office Suite

Job description

Liberty Dental Plan in the United States is seeking a Senior Staff Dentist to lead utilization management and clinical review, mentor staff, and support quality initiatives across Commercial, Medicare Advantage, and Medicaid programs.

The role reports to a State Dental Director and ensures timely, accurate coverage determinations while upholding regulatory compliance, quality outcomes, and financial stewardship.