Staff Dentist (Part-Time, Remote, Nevada /California License)

Liberty Dental Plan; Tustin, Nevada (CA, IA); Remote; USD 101,942 - 112,963; Part time

Benefits offered by this job

Fully remote position

20 hours per week

Competitive hourly pay

401(k) employer match

EAP and wellness benefits

Paid holidays and vacation accrual

Hybrid/remote work options

Job summary

Liberty Dental Plan is seeking an experienced Staff Dentist to support Utilization Management and Utilization Review programs. This fully remote, part‑time role (20 hours/week) focuses on reviewing dental claims, prior authorizations, referrals, and treatment requests across commercial and government programs.

The ideal candidate has a DDS/DMD, NJ license, at least 6 years of practice, and strong knowledge of coding, medical necessity, and regulatory standards.

Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active New Jersey dental license in good standing.
• Minimum of six (6) years of experience as a practicing dentist.
• Ability to complete Liberty Dental Plan credentialing requirements.
• Knowledge of dental procedures, coding standards, and medical necessity criteria.
• Ability to review radiographs, treatment plans, and chart documentation.
• Excellent written and verbal communication skills.
• Ability to manage review volumes efficiently while maintaining quality.

Responsibilities

• Review dental claims, referrals, and prior authorization requests across multiple lines of business.
• Apply clinical expertise to evaluate treatment plans, radiographs, chart notes, and supporting documentation.
• Make coverage determinations based on benefit plans, clinical guidelines, medical necessity criteria, and applicable policies.
• Meet established productivity, quality, and turnaround‑time standards.
• Document clinical rationale clearly and accurately in accordance with regulatory and accreditation requirements.
• Participate in calibration sessions to promote consistency and accuracy in clinical decision‑making.
• Complete inter‑rater reliability assessments and support ongoing quality improvement efforts.
• Collaborate with leadership and peers to address complex clinical scenarios and interpretation questions.
• Incorporate audit findings and feedback to continuously enhance determination accuracy and documentation quality.
• Conduct peer‑to‑peer consultations with treating providers regarding clinical determinations and treatment alternatives.
• Participate in grievance, appeal, and secondary review activities.
• Consult with dental specialists and subject matter experts as needed to support informed clinical decision‑making.
• Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicaid programs.
• Support regulatory reporting and accreditation‑related activities.
• Stay current with ADA CDT coding updates, evidence‑based treatment guidelines, and state‑specific requirements.

Skills

Communication skills

Regulatory understanding

Clinical decision making

Education

DDS or DMD degree

New Jersey dental license

Job description

Job Details

Location: Englishtown, NJ (fully remote). Position Type: Part Time (20 hours per week). Compensation: $74.00–$82.00 per hour.

About the Role

Liberty Dental Plan seeks an experienced Staff Dentist to support our Utilization Management (UM) and Utilization Review (UR) programs. The role involves reviewing dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace Exchange, Medicare Advantage, and Medicaid populations, ensuring evidence‑based access to care while supporting quality outcomes and regulatory compliance.

What You’ll Do

Utilization Management & Clinical Review

• Review dental claims, referrals, and prior authorization requests across multiple lines of business.
• Apply clinical expertise to evaluate treatment plans, radiographs, chart notes, and supporting documentation.
• Make coverage determinations based on benefit plans, clinical guidelines, medical necessity criteria, and applicable policies.
• Meet established productivity, quality, and turnaround‑time standards.
• Document clinical rationale clearly and accurately in accordance with regulatory and accreditation requirements.

Clinical Quality & Consistency

• Participate in calibration sessions to promote consistency and accuracy in clinical decision‑making.
• Complete inter‑rater reliability assessments and support ongoing quality improvement efforts.
• Collaborate with leadership and peers to address complex clinical scenarios and interpretation questions.
• Incorporate audit findings and feedback to continuously enhance determination accuracy and documentation quality.

Provider Engagement & Peer Collaboration

• Conduct peer‑to‑peer consultations with treating providers regarding clinical determinations and treatment alternatives.
• Participate in grievance, appeal, and secondary review activities.
• Consult with dental specialists and subject matter experts as needed to support informed clinical decision‑making.

Regulatory & Operational Support

• Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicaid programs.
• Support regulatory reporting and accreditation‑related activities.
• Stay current with ADA CDT coding updates, evidence‑based treatment guidelines, and state‑specific requirements.
• Participate in required training programs, departmental meetings, and organizational initiatives.

What You’ll Bring

Required Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted New Jersey dental license in good standing.
• Minimum of six (6) years of experience as a practicing dentist.
• Ability to successfully complete Liberty Dental Plan credentialing and recredentialing requirements.
• Strong knowledge of dental procedures, clinical guidelines, coding standards, and medical necessity criteria.
• Ability to review and interpret dental radiographs, treatment plans, and chart documentation.
• Excellent written and verbal communication skills.
• Ability to manage review volumes efficiently while maintaining quality and compliance standards.

Preferred Qualifications

• Experience in dental claims review, utilization management, managed care, or payer environments.
• Experience training, coaching, or mentoring clinical peers.
• Familiarity with claims adjudication systems and clinical review platforms.
• Experience with AI‑assisted review technologies such as Overjet or similar solutions.
• Exposure to project management and quality improvement initiatives.

Knowledge, Skills & Abilities

• Understanding of commercial, Medicare, Medicaid, and managed care dental programs.
• Knowledge of reimbursement methodologies, utilization management principles, and regulatory requirements.
• Ability to clearly communicate and support evidence‑based clinical determinations.
• Strong computer proficiency and the ability to quickly learn new technology platforms.
• Ability to work effectively in a collaborative, team‑oriented environment.
• Commitment to maintaining all required licensure and continuing education requirements.

Benefits

• Make a meaningful impact on the oral health of diverse member populations.
• Apply your clinical expertise in a collaborative, mission‑driven organization.
• Help drive quality, consistency, and innovation in dental utilization management.
• Work alongside experienced dental and healthcare professionals dedicated to improving access to care.
• Enjoy the flexibility of a fully remote position with a predictable 20‑hour‑per‑week schedule and competitive hourly compensation.
• Competitive pay structure and savings options to help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Employee Assistance Program (EAP) to support mental health and well‑being.
• Generous vacation and sick leave policies, with the ability to roll over unused time.
• Paid company holidays.
• Remote or hybrid work options available for various positions.

Compensation

Hourly rate: $74.00–$82.00 per hour (base salary). Fringe benefits and potential bonuses are not included.

Equal Opportunity Employer

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship is available at this time.

We comply with all applicable laws and regulations on non‑discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.