Staff Dentist
4 weeks ago
We are seeking a highly skilled Staff Dentist to join our team at Liberty Dental Plan. As a Staff Dentist, you will play a critical role in ensuring the timely oral health decision-making and adjudication of dental claims and prospective requests for dental services across all lines of business.
Key Responsibilities- Conduct clinical review of claims and pre-authorizations for all lines of business and/or markets as needed to ensure Liberty meets their contractual regulatory timeframes.
- Participate in all clinical trainings, calibrations, and Interrater reliability testing while also meeting all required quality and calibration benchmarks required by Liberty and state/federal regulations.
- Participate and/or complete Quality Management and Improvement activities, DCM and SIU activities (provider site reviews/or consultations, utilization management and utilization review analysis, counseling calls, etc.) and recommend actions to resolve identified provider trends and treatment patterns.
- Conduct Peer-to-Peer calls to discuss utilization trends, quality issues, and trends in prospective and retrospective claims submissions.
- Conduct secondary reviews such as grievance and appeal review.
- Identify potentially unnecessary services in relation to care delivery settings.
- Identify potential quality issues and trends in prospective and retrospective claims submissions.
- Examine dental charts for focused audits of aberrant utilization and care delivery patterns.
- Occasional on-site chart review for the state provider network.
- Attend meetings of supervisory and administrative staff to discuss department operations, clinical findings, and staff training needs.
- Use clinical expertise to make appropriate dental interpretations and decisions, as required.
- Develop and maintain subject matter expertise in Liberty dental benefit plans and applicable State Medicaid Programs.
- As requested, contribute to required regulatory reporting.
- Participate in Quality Improvement and Provider Credentialing Committees and provide input on appropriate resolution of member and/or provider grievances.
- Collect and evaluate data from Grievance, Peer Review, Public Policy, and the Credentialing Sub-Committee on a quarterly basis.
- Participate in enrollee Tele-dentistry visits to provide clinical assessment, evaluations, and recommendations based on dental need.
- May consult periodically with Dental Board-eligible and/or certified specialist or academic specialist within the community to make informed decision for individual enrollees.
- Minimum DDS/DMD Degree.
- Active, unrestricted license or certification to practice dental or related health profession in California in good standing (must pass credentialing - no probation or listed sanctions).
- Minimum 5 years of clinical dentistry experience.
- Demonstrated performance in managing oral health care cost and utilization management.
- In-depth knowledge of commercial and managed care delivery systems, reimbursement mechanisms, state regulatory and legislative landscape, and quality improvement initiatives.
- Knowledge of clinical dentistry procedure codes and generally accepted clinical and adjudication guidelines on medical necessity of proposed dental procedures.
- Ability to examine and read dental radiographs and chart records.
- Ability to be successfully credentialed and re-credentialed by Liberty Dental Plan.
- Must comply with applicable federal and state statutes and regulations.
- Project management exposure with the ability to create and implement plans successfully.
- Computer literacy with the ability to easily acquire working knowledge of new system applications.
- Ability to apply alternate benefits where applicable, and consistent with plan guidelines and/or generally accepted professional protocols or guidelines.
- Ability to work in a team providing leadership and implementing the consensus or organizational required activities.
- Complete all necessary CE credits associated with maintaining your dental licensure.
- Additional state licensures may be needed to meet regulatory needs of the company.
Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.
CompensationIn the spirit of pay transparency, we are excited to share the base salary for this position is $129,099 - $167,829, exclusive of fringe benefits or potential bonuses. If you are hired at Liberty, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and/or experience. In addition to those factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued salary growth.
About Liberty Dental PlanLiberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high-performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.
Sponsorship and Relocation Specifications: Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.
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