Senior Staff Dentist: UM & Quality Leader (Remote)

LIBERTY DENTAL PLAN CORPORATION; New York (NY); Hybrid; USD 175.000 - 185.000; Vollzeit

Benefits dieser Stelle

Competitive pay

401(k) with employer match

Medical insurance

Dental coverage for employees

Vision insurance

Life insurance

Flexible Spending Accounts

Wellness programs

EAP

Paid vacation

Holidays

Tuition reimbursement

Remote or hybrid work options

Zusammenfassung

LIBERTY Dental Plan Corporation seeks a Senior Staff Dentist to provide clinical leadership in utilization management and review across Commercial, Medicare Advantage, and Medicaid programs. You will adjudicate claims, mentor staff, and drive quality improvement while ensuring regulatory compliance.

The role emphasizes collaboration with providers and cross-functional teams to improve care quality and patient outcomes on a broader scale.

Qualifikationen

• DHS or DMD degree from an accredited dental school.
• Current, active, and unrestricted dental license in good standing.
• Ability to obtain and maintain credentialing with LIBERTY Dental Plan.
• Minimum of 6 years of experience as a practicing dentist.
• Minimum of 2 years in quality initiatives, utilization management, claims review or related clinical review.
• Experience with Medicaid dental programs is required.
• Proficiency with Microsoft Office and multiple clinical applications.

Aufgaben

• Lead utilization management and clinical review for all lines of business to ensure timely, accurate adjudication of dental claims and prior authorizations.
• Apply clinical judgment to interpret records and benefit structures for coverage determinations.
• Identify unnecessary services and inappropriate care settings and monitor utilization trends.
• Participate in quality improvement, provider engagement, and peer review activities.
• Mentor staff dentists and lead calibration to ensure consistent reviews.
• Collaborate with specialists to support complex clinical decision-making.

Kenntnisse

Quality initiatives

Utilization management

Claims review

Prior authorization review

Medicaid experience

Dental license in good standing

Ausbildung

DDS/DMD or equivalent

Tools

Microsoft Office

Jobbeschreibung

LIBERTY Dental Plan Corporation seeks a Senior Staff Dentist to provide clinical leadership in utilization management and review across Commercial, Medicare Advantage, and Medicaid programs. You will adjudicate claims, mentor staff, and drive quality improvement while ensuring regulatory compliance.

The role emphasizes collaboration with providers and cross-functional teams to improve care quality and patient outcomes on a broader scale.