Staff Orthodontist (Part-Time)

Job Details

Job Location: LIBERTY Dental Plan Corp. - Tustin, CA 92782Position Type: Part TimeJob Shift: DayJob Category: Dental

Join Liberty Dental Plan as We Shape the Future of Dental Insurance!

 

 

 

Liberty Dental Plan is seeking a Part-Time Staff Orthodontist with an Unrestricted license or certification to practice in the State of California to join our growing team! This is an exciting opportunity for an experienced orthodontic professional to leverage their expertise in a dynamic, collaborative environment.

 

 

 

About the Role

 

As Liberty’s subject matter expert in orthodontics, you will play a critical role in ensuring quality care and compliance across all markets. This position focuses on Utilization Management and Review, including orthodontic claims, pre-authorizations, and grievance and appeals processes. You’ll also represent Liberty in orthodontic hearings, edit provider reference materials, and contribute to quality improvement initiatives.

 

 

 

Key Responsibilities

• Conduct clinical review of orthodontic claims, pre-estimates, and specialty care referrals.

• Review grievance and appeals cases for orthodontic services for all states (as local state regulations permit), reviews are performed emphasizing consistency with established clinical protocols, criteria and guidelines, and adjudication principles.

• Request, collect and/or analyze data as needed.

   

• Represent Liberty in orthodontic fair hearings and provider disputes.

• Edit orthodontic language in Provider Reference Guides.

• Identifies potentially unnecessary services in relation to care delivery settings.
• Identifies potential quality issues and trends in prospective and retrospective claims submissions.

• Examines clinical programs information to identify members for specific case management and/or disease management activities or interventions by utilizing established screening criteria, as needed.

• Examines dental charts for focused audits of aberrant utilization and care delivery patterns.

• Performs occasional on-site chart review for the state provider network.

• Uses clinical experience and expertise to make appropriate dental interpretations and decisions, as required. 

• Meets with clients, regulators and stakeholders and communicates with them about Liberty’s programs as Liberty’s representative, when necessary.

• Participates in corporate ortho consultant training and calibration.
• Serve as a trusted advisor on orthodontic care standards and benefit administration.

• Performs other related duties as assigned.

Education & Experience

• DDS/DMD degree with orthodontic specialty certification.

• Active state dental license in good standing (must pass credentialing).

• Minimum 5 years of clinical orthodontic practice; experience reviewing claims preferred.

• Familiarity with commercial dental, Medicare Advantage, and Medicaid programs.

Skills & Knowledge

• Knowledge of orthodontic procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed orthodontic procedures.

  Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted professional protocols or guidelines.

• Familiar with concepts of Utilization Management and Utilization Review
• Can take direction regarding clinical criteria and guidelines

• Ability to assimilate and apply coverage guidelines consistently

• Computer literacy with ability to easily acquire working knowledge of new system applications. Possess, at minimum, basic Microsoft (Excel, Word and PowerPoint) skills.

• Knowledge of the state and its community standards of oral health