Senior Staff Dentist, Utilization Management (Remote) NY

Senior Staff Dentist, Utilization Management (Remote) NY

Fully Remote New York - NY

Help Shape the Future of Oral Health Care as a Senior Staff Dentist

Are you an experienced dentist looking to expand your impact beyond clinical practice? Join LIBERTY Dental Plan as a Senior Staff Dentist and play a critical role in improving quality, supporting providers, and ensuring members receive clinically appropriate, evidence-based dental care across Commercial, Medicare Advantage, and Medicaid programs.

In this influential clinical leadership role, you'll leverage your expertise to guide utilization management decisions, support quality improvement initiatives, mentor colleagues, and help drive better oral health outcomes on a broader scale.

About the Role

The Senior Staff Dentist reports to an assigned State Dental Director and provides clinical leadership and oversight for Utilization Management (UM) and Utilization Review (UR) programs. This role ensures timely, accurate, and clinically appropriate adjudication of dental claims and prospective service requests, including referrals and prior authorizations.

The Senior Staff Dentist plays a key role in quality and compliance activities, provider engagement, peer review, staff calibration, and clinical mentorship. This position supports all lines of business, including Commercial, Medicare Advantage, and Medicaid, while maintaining a strong focus on regulatory compliance, quality outcomes, and financial stewardship.

What You'll Do

Utilization Management & Clinical Review

• 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.

Quality, Compliance & Performance Improvement

• Participate in Quality Management and Performance Improvement activities.
• Support Provider Performance Management (PPM) and Special Investigations Unit (SIU) initiatives, including provider site reviews, utilization analysis, and provider counseling activities.
• Conduct focused and targeted dental chart audits to identify unusual utilization or care delivery patterns.
• Participate in Quality Improvement Committees and provide clinical expertise in the resolution of member and provider grievances.
• Collect, evaluate, and analyze data related to grievance, peer review, public policy, and credentialing activities.
• Support regulatory, compliance, and quality reporting requirements.

Provider Engagement & Peer Review

• Conduct peer-to-peer consultations with providers regarding utilization trends, quality concerns, and claims decisions.
• Support provider engagement initiatives focused on improving care quality, documentation, and compliance.
• Collaborate with dental specialists and subject matter experts to support complex clinical decision-making.
• Mentor staff dentists as appropriate and support clinical development initiatives.
• Lead and participate in calibration activities to ensure consistency and accuracy in clinical reviews.

Operational & Organizational Support

• Attend meetings with clinical and administrative leadership to discuss departmental operations, clinical findings, and training needs.
• Participate in state oral health programs and organizational initiatives.
• Develop and maintain expertise in LIBERTY Dental Plan products, benefits, and applicable Medicaid programs.
• Provide clinical guidance and support to Utilization Management and Claims teams.
• Perform occasional onsite chart reviews when required.

What You'll Bring

Required Qualifications

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted dental license in good standing.
• 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.
• Demonstrated experience reviewing dental claims, treatment plans, clinical documentation, and coverage determinations within a managed care or payer environment.
• Intermediate to advanced computer proficiency required, including Microsoft Office Suite and the ability to effectively utilize multiple business and clinical applications.

Preferred Qualifications

• Proficiency with New York Medicaid dental programs, benefits, regulations, policies, and clinical review requirements.
• Prior experience training, mentoring, or coaching peers.
• Experience supporting provider engagement initiatives, quality improvement programs, and clinical calibration activities.
• Experience working with Commercial and Medicare Advantage dental plans.

Knowledge, Skills & Abilities

• Demonstrated success managing oral healthcare costs and utilization management initiatives.
• In-depth knowledge of commercial and managed care delivery systems, reimbursement methodologies, and quality improvement programs.
• Expertise in dental procedure coding, claims adjudication, and medical necessity guidelines.
• Ability to review and interpret dental records, charts, treatment plans, and radiographs.
• Strong analytical, communication, and provider engagement skills.
• Intermediate to advanced proficiency with Microsoft Office Suite, including Outlook, Word, Excel, PowerPoint, and Teams.
• Advanced general computer skills preferred, including experience working within claims processing systems, utilization management platforms, electronic health records, workflow management systems, and reporting tools.
• Project management experience and the ability to successfully create and implement plans.
• Ability to work collaboratively across clinical and operational teams while providing leadership and guidance.
• Ability to quickly learn and effectively utilize new systems and technology.
• Ability to apply alternate benefits where appropriate and consistent with plan guidelines and accepted professional standards.
• Commitment to maintaining continuing education requirements and professional licensure.

Why Join LIBERTY Dental Plan?

At LIBERTY Dental Plan, you'll have the opportunity to use your clinical expertise to improve care on a broader scale. You'll collaborate with experienced healthcare professionals, influence quality outcomes, support providers, and help ensure members receive high-quality, clinically appropriate dental care.

This role offers the opportunity to combine clinical expertise, leadership, quality improvement, provider engagement, and strategic impact within an organization dedicated to advancing oral health and delivering exceptional service.

Ready to Make an Impact?

If you're passionate about clinical excellence, utilization management, quality improvement, and improving oral health outcomes for diverse populations, we encourage you to apply and become part of the LIBERTY Dental Plan team

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:

• 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.

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending