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.
Qualifications
Location
Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.
What Liberty Offers
Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.
Our first-class benefits package supports employees and their dependents with:
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Competitive pay structure and savings options to help you reach your financial goals.
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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.
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Employee Assistance Program (EAP) to support mental health and well-being.
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Generous vacation and sick leave policies, with the ability to roll over unused time.
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Paid company holidays.
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Remote or hybrid work options available for various positions.
Compensation
In the spirit of pay transparency, the base salary range for this position is $74.00 - $82.00 an hour, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.
Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.
Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.
Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.
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.
Sponsorship and Relocation Specifications
Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.
No relocation assistance or sponsorship available at this time.
DDS or DMD, unrestricted U.S. dental license, and at least 6 years of practicing dentistry required. Requires Medicaid and Medicare Advantage experience, clinical review expertise, and strong computer and written communication skills.
Key Responsibilities
- reviewing claims
- making determinations
- documenting rationales
Skills & Tools
Overjet
Job Details
- Category: Healthcare Services - Advanced Practice
- Seniority: Senior Level
- Commitment: Part Time
- Workplace: Remote — United States or Tustin
- Salary: USD 153,920 – 170,560 / year
- Languages: English
Benefits
- 401k matching
- Generous paid time off
- Retirement plan
About Liberty Dental Plan
A dental benefits organization improving access to affordable, evidence-based oral healthcare. — Industry: Healthcare