This a Full Remote job, the offer is available from: Oklahoma (USA)

Help Shape Better Oral Health Outcomes at Liberty Dental Plan

At Liberty Dental Plan, our mission is to improve oral health by delivering high-quality, accessible, and cost-effective dental benefits. We are seeking an experienced Staff Dentist to join our clinical team and play a critical role in supporting our Utilization Management (UM) and Utilization Review (UR) programs.

This fully remote opportunity offers a consistent 20-24 hour-per-week schedule, allowing experienced dentists to apply their clinical expertise in a collaborative managed care environment while helping improve access to high-quality oral healthcare. You will review dental claims, prior authorizations, referrals, and treatment requests across Commercial, Marketplace Exchange, Medicare Advantage, and Medicaid populations, helping ensure members receive appropriate, evidence-based care while supporting quality outcomes and regulatory compliance.

About the Role

The Staff Dentist (Part-Time) is responsible for performing timely, accurate, and clinically sound reviews of dental claims and service requests. Working closely with providers, dental leadership, and cross-functional teams, you will support consistent coverage determinations, quality improvement initiatives, and exceptional member experiences.

Employment Type: Part-Time, Non-Exempt
Work Arrangement: Fully Remote
Schedule: 20 - 24 hours per week
Compensation: $74.00 - $82.00 per hour

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 Medicare & 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, unrestricted dental license in good standing from any U.S. state or territory.
• Minimum of six (6) years of experience as a practicing dentist.
• Experience working with Medicaid and Medicare Advantage dental programs.
• Demonstrated ability to efficiently manage high-volume clinical review queues while maintaining exceptional accuracy, quality standards, and compliance with regulatory and internal turnaround time requirements.
• 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.
• Strong computer proficiency and the ability to quickly learn new technology platforms.
• Excellent written communication skills with the ability to develop clear and defensible clinical determinations.

Preferred Qualifications

• Prior experience reviewing dental claims, prior authorizations, utilization management cases, or clinical determinations within a payer, managed care, dental benefits, or health plan environment.
• Experience conducting peer-to-peer provider consultations.
• Experience supporting grievances, appeals, and secondary clinical reviews.
• Familiarity with clinical review platforms, claims adjudication systems, and AI-assisted review technology such as Overjet.
• Knowledge of NCQA and URAC utilization management standards.
• Experience training, mentoring, or calibrating clinical review teams.
• Project management or process improvement experience.

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.

What Success Looks Like

• Consistently meets or exceeds productivity, quality, and turnaround-time benchmarks.
• Effectively manages high-volume claims and authorization review queues without sacrificing clinical accuracy.
• Produces clear, defensible clinical rationales that support sound coverage determinations.
• Collaborates effectively with providers, peers, and leadership to ensure consistent application of clinical guidelines and benefit policies.

Why Join Liberty Dental Plan?

• 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 - 24 hour-per-week schedule and competitive hourly compensation.

Ready to Make an Impact?

Apply today and help Liberty Dental Plan deliver quality, affordable, and accessible dental care through clinical excellence and evidence-based decision-making.