[Hiring] Senior Staff Dentist @LIBERTY DENTAL PLAN CORPORATION

Role Description

LIBERTY Dental Plan is seeking a highly experienced and collaborative Senior Staff Dentist to provide clinical leadership across our Utilization Management (UM) and Utilization Review (UR) programs. This role is ideal for a dentist with experience in the dental benefits (payer) environment who is passionate about improving care quality, ensuring compliance, and driving better health outcomes.

You will play a key role in reviewing claims and prior authorizations, partnering with providers, and supporting care delivery across Commercial, Medicare Advantage, and Medicaid populations—particularly within California Medicaid (Medi-Cal) programs.

What You’ll Do

• Clinical Review & Utilization Management
  • Review dental claims, referrals, and prior authorization requests to ensure medical necessity and regulatory compliance.
  • Interpret dental records, radiographs, and benefit plans to make clinically sound coverage determinations.
  • Identify utilization trends, inappropriate services, and opportunities to improve care delivery.
  • Conduct retrospective reviews and influence provider behavior through engagement.
  • Perform secondary reviews, including grievances and appeals determinations.
• Quality & Compliance
  • Participate in Quality Improvement and Performance Management initiatives (PPM, SIU).
  • Conduct focused chart audits to identify utilization and care delivery patterns.
  • Contribute to quality committees and regulatory reporting.
  • Provide clinical expertise in resolving provider and member grievances.
• Provider Engagement & Collaboration
  • Conduct peer-to-peer consultations with network providers.
  • Promote provider education and engagement to improve documentation and care quality.
  • Collaborate with specialists and internal teams on complex cases.
• Cross-Functional Partnership
  • Work closely with Analytics, Utilization Management, Claims, Provider Relations, and G&A teams.
  • Partner with leadership on clinical initiatives, training, and operational improvements.
  • Participate in state oral health initiatives and internal programs.

A Day in the Life

• ~30% peer-to-peer provider calls
• ~30% clinical reviews (DCM and HCA work)
• ~25% appeals and case reviews
• ~15% supporting clinical leadership and special projects

Qualifications

• DDS or DMD degree
• Active, unrestricted California dental license required
• Must be in good standing and eligible for credentialing
• Minimum 6 years of experience as a practicing dentist
• Minimum 2 years of experience in utilization management, claims review, or quality initiatives
• Strong clinical judgment and ability to interpret dental radiographs and patient records

Preferred Qualifications

• Experience in the dental benefits or payer environment
• Familiarity with California Medicaid (Medi-Cal) programs
• Ability to obtain and maintain multi-state licensure (company-supported)
• Arizona license preferred
• Experience mentoring or training clinical peers

Key Skills

• Knowledge of managed care, reimbursement systems, and regulatory compliance
• Expertise in dental coding, clinical guidelines, and medical necessity criteria
• Strong communication and interpersonal skills for provider engagement
• Analytical mindset with the ability to identify trends and drive improvements
• Proficiency in Microsoft Office and ability to learn new systems

Benefits

• 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 Accounts for healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, and gym discounts.
• 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.
• 10 paid company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work options available for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $175,000 - $185,000 annually, 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.

Interview Process

• Initial recruiter screening
• 45-minute interview with Hiring Manager
• Final selection following candidate review

Sponsorship and Relocation Specifications

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