Staff Dentist – Part-Time, New Jersey License

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

📋 Description

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

• Utilize clinical expertise to assess treatment plans, radiographs, chart notes, and relevant documentation.

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

• Achieve established productivity, quality, and turnaround-time benchmarks.

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

• Engage in calibration sessions to ensure consistency and accuracy in clinical decision-making.

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

• Work collaboratively with leadership and colleagues to address intricate clinical scenarios and interpretation inquiries.

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

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

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

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

• Maintain expertise in Liberty Dental Plan benefit structures and relevant Medicaid programs.

• Assist in regulatory reporting and accreditation-related tasks.

• Keep updated with ADA CDT coding changes, evidence-based treatment guidelines, and state-specific requirements.

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

⛳️ Requirements

• DDS or DMD degree from a recognized dental institution.

• Active, current, and unrestricted dental license in good standing in New Jersey.

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

• Capability to successfully fulfill Liberty Dental Plan credentialing and recredentialing prerequisites.

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

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

• Strong written and verbal communication abilities.

• Skill in managing review volumes efficiently while upholding quality and compliance standards.

🏝️ Benefits

• Competitive pay structure and savings opportunities to help you achieve your financial objectives.

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

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

• Generous vacation and sick leave policies, allowing for rollover of unused time.

• Paid holidays provided by the company.

• Options for remote or hybrid work available for various roles.