Remote Nicu Utilization Review Jobs in Riverside, CA

Are you a senior dental leader who thrives at the intersection of clinical excellence, healthcare affordability, quality improvement, and strategic leadership? Join Liberty Dental Plan as our Senior Director, Dental and help drive innovative programs, influence enterprise-wide strategy, and improve oral health outcomes for the communities we serve.

Location: Remote
Employment Type: Full-Time
FLSA Status: Exempt

The Senior Director, Dental serves as the clinical leader for Liberty Dental Plan's Medicaid line of business, providing enterprise-wide oversight of utilization management, clinical policy development, regulatory compliance, quality initiatives, provider engagement, and clinical performance.

This highly visible leadership role is responsible for guiding State Dental Directors and clinical teams while ensuring dental programs remain aligned with evidence-based standards, regulatory requirements, organizational goals, and member needs. The ideal candidate brings deep dental managed care experience, strong business acumen, and a passion for improving quality, affordability, and access to care.

• Serve as the clinical authority for Medicaid dental utilization management across assigned markets.
• Develop, review, and maintain clinical policies, utilization management criteria, and practice guidelines aligned with ADA standards, CMS requirements, and state regulations.
• Lead, mentor, and support State Dental Directors, Staff Dentists, and clinical team members.
• Facilitate clinical calibration exercises and quality review activities to ensure consistency in clinical decision-making.
• Participate in clinical governance committees and strategic organizational initiatives.

• Oversee dental prior authorization, retrospective review, appeals, and utilization management programs.
• Ensure decisions are evidence-based, timely, compliant, and clinically sound.
• Analyze utilization trends and identify opportunities to improve quality outcomes and healthcare affordability.
• Guide staffing, training, calibration, and performance expectations for utilization management clinicians and reviewers.

• Serve as the clinical subject matter expert during audits, regulatory reviews, readiness assessments, and corrective action initiatives.
• Partner with state agencies, regulators, and internal stakeholders to support compliance requirements.
• Monitor changes in Medicaid regulations and drive operational improvements as needed.
• Provide expert clinical guidance on complex grievances, appeals, and escalated cases.

• Lead initiatives focused on improving access, health outcomes, member experience, and preventive care.
• Support the development and implementation of care management programs and high-risk member outreach strategies.
• Drive engagement and expansion of value-based care initiatives across the organization.
• Promote innovative solutions, including teledentistry and emerging care delivery models.
• Collaborate with Quality Improvement teams to design and implement programs that improve clinical performance and outcomes.

• Serve as a clinical liaison to provider networks, dental associations, academic partners, and key stakeholders.
• Support provider education efforts related to utilization management criteria, coding requirements, benefit policies, and quality initiatives.
• Participate in Medicaid procurements, RFP responses, market implementations, and expansion opportunities.
• Collaborate with provider partners and market leaders to address utilization trends and improve performance.

• Partner with Clinical Performance, Analytics, and Actuarial teams to identify opportunities that improve affordability and quality.
• Help shape the clinical analytics roadmap and reporting strategy.
• Support the development of dashboards and reporting tools that drive informed decision-making.
• Leverage managed care principles and data-driven insights to improve clinical and financial outcomes.

• Lead, coach, and develop high-performing teams through clear communication, accountability, and continuous feedback.
• Foster an engaged, collaborative, and inclusive culture that promotes trust, teamwork, and employee growth.
• Drive business results by setting priorities, making data-informed decisions, and ensuring effective execution.
• Empower team members through delegation, development opportunities, and ownership of outcomes.
• Build strong stakeholder partnerships and influence cross-functional initiatives to achieve organizational goals.
• Champion innovation, continuous improvement, and calculated risk-taking to enhance team and business performance.
• Consistently model company values, demonstrating integrity, emotional intelligence, and leadership excellence.

• Partner closely with leaders across Quality, Analytics, Provider Relations, Operations, Compliance, Claims, Network Management, Product, and Member Services.
• Provide clinical input for strategic planning, operational enhancements, reporting initiatives, and enterprise projects.
• Represent Dental leadership in executive-level discussions and organizational decision-making.

• DDS or DMD degree from an accredited dental school.
• Active, unrestricted dental license in at least one U.S. state.
• Minimum of 12 years of clinical dental experience.
• 3+ years of experience in utilization management, managed care, dental insurance, payer organizations, or Medicaid-focused healthcare environments.
• 3+ years of people leadership, technical leadership, or functional management experience.
• Proven success leading, coaching, and developing high-performing teams.
• Deep knowledge of dental managed care, benefit structures, reimbursement methodologies, utilization management, and authorization workflows.
• Experience developing clinical policies, managing utilization programs, and supporting regulatory compliance initiatives.
• Strong understanding of Medicaid programs and government-funded healthcare environments.
• Exceptional leadership, communication, relationship-building, analytical, and strategic thinking skills.
• Ability to influence executive stakeholders and lead complex organizational initiatives.

• Advanced degree in Public Health, Health Administration, Health Policy, Business Administration (MBA), or a related field.
• Experience leading multi-state Medicaid programs or national payer initiatives.
• Experience collaborating with state Medicaid agencies and participating in regulatory audits.
• Knowledge of value-based care models, provider performance management, and quality improvement strategies.
• Familiarity with teledentistry and digital health solutions.

This is a rare opportunity to shape the future of Medicaid dental care at a national level. As Senior Director, Dental, you will lead experienced Dental Directors across multiple markets, influence enterprise-wide clinical strategy, and drive initiatives that improve health outcomes for the members and communities we serve.

You'll join a mission-driven organization committed to delivering high-quality, affordable, and equitable oral healthcare while advancing innovative care models that create lasting impact.

If you're a visionary dental managed care leader with deep Medicaid expertise, a passion for developing leaders, and a commitment to improving quality and affordability, we invite you to apply and help shape the future of oral healthcare at Liberty Dental Plan.

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.

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

• Competitive pay structure and savings options to help you reach your financial goals.

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

• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance with low-cost premiums for employee-only coverage and dependents.

• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.

• Flexible Spending Accounts for healthcare and dependent care expenses.

• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.

• Long-term disability coverage.

• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

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

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

• 10 paid company holidays.

• Tuition reimbursement for eligible educational expenses.

• Remote or hybrid work options available for various positions.

In the spirit of pay transparency, the base salary range for this position is $168,500 - $218,000 annually, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty 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.

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.