Senior Staff Dentist

Job DetailsJob Location: New Jersey, Staten Island and the Bronx, NY - New Jersey, NJPosition Type: Full TimeJob Category: Dental
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About the Role

LIBERTY Dental Plan is seeking an experienced and clinically driven Senior Staff Dentist to join our Clinical Affairs team. In this leadership role, you will help ensure the delivery of high-quality, cost-effective dental care by providing clinical oversight of utilization management and claims review processes.

This position offers the opportunity to influence care quality and provider engagement across Commercial, Medicare Advantage, and Medicaid programs while contributing to meaningful oral health initiatives. You’ll collaborate with cross-functional teams and serve as a mentor and clinical resource to support consistent, evidence-based decision-making across the organization.

** This role requires an Active, unrestricted New Jersey dental license in good standing **


What You’ll Do

Clinical Review & Utilization Management


Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations
Interpret dental records, radiographs, and benefit structures to assess medical necessity and coverage decisions
Identify inappropriate utilization patterns and recommend improvements to align with best practices
Conduct retrospective utilization reviews and support provider behavior change initiatives
Complete appeal, grievance, and secondary review determinations


Quality, Compliance & Improvement


Participate in quality management and performance improvement programs, including audits and provider performance initiatives
Conduct chart reviews to identify trends in care delivery and utilization
Support grievance resolution and contribute to regulatory reporting and compliance activities
Provide clinical insight during committee reviews and quality improvement efforts


Provider Engagement & Peer Collaboration


Lead peer-to-peer consultations with providers to discuss clinical decisions, utilization trends, and quality concerns
Support provider education around compliance, documentation, and care standards
Partner with specialists and subject matter experts on complex clinical cases


Leadership & Organizational Impact


Mentor staff dentists and support clinical calibration efforts to ensure consistency across reviews
Provide guidance to utilization management and claims teams
Collaborate with Analytics, Claims, UM, and outreach teams to improve operational outcomes
Participate in state oral health initiatives and organizational programs



A Day in the Life

In this role, your day is a blend of clinical review, collaboration, and quality improvement work:


~75% reviewing dental claims and utilization requests to ensure accuracy, compliance, and appropriate care decisions
~10% supporting quality initiatives, including investigating clinical trends and addressing care concerns
~5% handling expedited reviews with quick turnaround times to support members and providers
~5% participating in care management or interdisciplinary coordination efforts
~5% engaging in team collaboration, provider discussions, and other organizational priorities


You’ll regularly partner with teams across Analytics, Utilization Management, Claims, and Provider Outreach, while also connecting directly with network dentists through peer-to-peer consultations.


What You’ll Bring

Required Qualifications


DDS or DMD from an accredited institution
Active, unrestricted New Jersey dental license in good standing (required)
Ability to obtain additional state licenses as needed (company-supported)
Minimum 6 years of experience as a practicing dentist
At least 2 years of experience in utilization management, claims review, or quality improvement initiatives


Preferred Qualifications


Experience in the dental benefits or managed care industry
Experience mentoring or training peers
Multi-state licensure
Familiarity with Medicaid programs


Key Skills & Expertise


Strong clinical judgment and knowledge of dental procedures, coding, and adjudication guidelines
Ability to interpret radiographs and dental records
Knowledge of managed care systems, reimbursement models, and regulatory requirements
Experience identifying fraud, waste, and abuse trends
Strong collaboration, communication, and provider engagement skills
Proficiency with Microsoft Office and ability to learn new systems quickly



Work Environment & Impact


Remote role with collaboration across national teams
High-impact role shaping clinical standards and improving member outcomes



Compensation


Salary Range: $175,000 – $185,000 annually
(Fi