Chart Utilization Review Jobs in California (NOW HIRING)

Job Details: Location: Nevada - NV | Position Type: Part Time | Job Category: Dental

The Staff Dentist will support Liberty Dental Plan’s Utilization Management and Utilization Review programs by evaluating dental claims, prior authorizations, referrals, and treatment requests for multiple payer lines, ensuring evidence‑based decision making while maintaining quality and compliance.

• Review dental claims, referrals, and prior authorization requests across multiple lines of business.
• Apply clinical expertise to evaluate treatment plans, radiographs, chart notes, and supporting documentation.
• Make coverage determinations based on benefit plans, clinical guidelines, medical necessity criteria, and applicable policies.
• Meet established productivity, quality, and turnaround‑time standards.
• Document clinical rationale clearly and accurately in accordance with regulatory and accreditation requirements.

• Participate in calibration sessions to promote consistency and accuracy in clinical decision‑making.
• Complete inter‑rater reliability assessments and support ongoing quality improvement efforts.
• Collaborate with leadership and peers to address complex clinical scenarios and interpretation questions.
• Incorporate audit findings and feedback to continuously enhance determination accuracy and documentation quality.

• Conduct peer‑to‑peer consultations with treating providers regarding clinical determinations and treatment alternatives.
• Participate in grievance, appeal, and secondary review activities.
• Consult with dental specialists and subject matter experts as needed to support informed clinical decision‑making.

• Maintain expertise in Liberty Dental Plan benefit structures and applicable Medicaid programs.
• Support regulatory reporting and accreditation‑related activities.
• Stay current with ADA CDT coding updates, evidence‑based treatment guidelines, and state‑specific requirements.
• Participate in required training programs, departmental meetings, and organizational initiatives.

• DDS or DMD degree from an accredited dental school.
• Current, active, and unrestricted Nevada dental license in good standing.
• Minimum of six (6) years of experience as a practicing dentist.
• Ability to successfully complete Liberty Dental Plan credentialing and recredentialing requirements.
• Strong knowledge of dental procedures, clinical guidelines, coding standards, and medical necessity criteria.
• Ability to review and interpret dental radiographs, treatment plans, and chart documentation.
• Excellent written and verbal communication skills.
• Ability to manage review volumes efficiently while maintaining quality and compliance standards.

• Experience in dental claims review, utilization management, managed care, or payer environments.
• Experience training, coaching, or mentoring clinical peers.
• Familiarity with claims adjudication systems and clinical review platforms.
• Experience with AI‑assisted review technologies such as Overjet or similar solutions.
• Exposure to project management and quality improvement initiatives.

• Understanding of commercial, Medicare, Medicaid, and managed care dental programs.
• Knowledge of reimbursement methodologies, utilization management principles, and regulatory requirements.
• Ability to clearly communicate and support evidence‑based clinical determinations.
• Strong computer proficiency and the ability to quickly learn new technology platforms.
• Ability to work effectively in a collaborative, team‑oriented environment.
• Commitment to maintaining all required licensure and continuing education requirements.

Hourly rate: $74.00 – $82.00 per hour. Compensation may vary based on geographic location, skills, education, and experience. Additional benefits include 401(k) with employer match, employee assistance program, paid holidays, and a predictable 20‑hour‑per‑week schedule.

Liberty Dental Plan is an Equal Opportunity Employer. We comply with all applicable laws and regulations regarding non‑discrimination in employment and recruitment. We are a sponsor of VETS and Disabled.

If you are a licensed Nevada dentist passionate about clinical excellence, evidence‑based decision‑making, and improving oral health outcomes, we encourage you to apply today and join Liberty Dental Plan’s dedicated clinical team.