Staff Dentist, Part-Time, Nevada License

This is a fully remote position, open to applicants in Nevada.

📋 Description

• Assess dental claims, referrals, and prior authorization requests across various lines of business.

• Utilize clinical expertise to analyze treatment plans, radiographs, chart notes, and supporting documents.

• Make decisions on coverage based on benefit plans, clinical guidelines, medical necessity criteria, and relevant policies.

• Achieve established productivity, quality, and turnaround time metrics.

• Clearly and accurately document clinical rationale in compliance with regulatory and accreditation standards.

• Engage in calibration sessions to foster consistency and precision in clinical decision-making.

• Conduct inter-rater reliability assessments and contribute to ongoing quality improvement initiatives.

• Work collaboratively with leadership and colleagues to tackle complex clinical situations and interpretation inquiries.

• Utilize audit findings and feedback to continually improve determination accuracy and documentation quality.

• Facilitate peer-to-peer consultations with treating providers regarding clinical determinations and treatment options.

• Involve in grievance, appeal, and secondary review processes.

• Consult with dental specialists and subject matter experts as necessary to support informed clinical decisions.

• Maintain up-to-date knowledge of Liberty Dental Plan benefit structures and relevant Medicaid programs.

• Assist with regulatory reporting and accreditation-related tasks.

• Stay informed on ADA CDT coding updates, evidence-based treatment guidelines, and state-specific regulations.

• Take part in mandatory training programs, departmental meetings, and organizational initiatives.

⛳️ Requirements

• DDS or DMD degree from a recognized dental school.

• Valid, active, and unrestricted dental license in Nevada in good standing.

• At least six (6) years of experience as a practicing dentist.

• Capability to successfully meet Liberty Dental Plan credentialing and recredentialing standards.

• Comprehensive knowledge of dental procedures, clinical guidelines, coding standards, and medical necessity criteria.

• Proficiency in reviewing and interpreting dental radiographs, treatment plans, and chart documentation.

• Strong written and verbal communication abilities.

• Capacity to efficiently manage review volumes while upholding quality and compliance standards.

🏝️ Benefits

• Competitive pay structure and savings options to assist you in achieving your financial objectives.

• Exceptional 401(k) retirement benefits, including employer matching, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.

• Employee Assistance Program (EAP) to promote mental health and well-being.

• Generous vacation and sick leave policies, with the option to roll over unused time.

• Paid company holidays.

• Remote or hybrid work options available for various roles.