Remote Non Clinical Rn Jobs in Riverside, CA (NOW HIRING)

We are seeking an experienced Staff Dentist (1099 Independent Contractor) to support Utilization Management (UM) and Utilization Review (UR) functions across our dental plans. This is a fully remote, non-clinical, review-focused role ideal for dentists who want to apply their clinical expertise to drive quality, compliance, and appropriate care delivery at scale.

In this role, you will perform clinical reviews of claims, prior authorizations, and referrals across Commercial, Medicare Advantage, and Medicaid lines of business, helping ensure regulatory compliance, cost-effective care, and high-quality oral health outcomes.

• Work Type: 100% Remote (U.S.-based)
• Contract Type: 1099 Independent Contractor
• Duration: 6-month assignment with potential for extension
• Schedule: Flexible, based on business needs
• Licensure: Active, unrestricted dental license in California or New Jersey is required; candidates without one of these state licenses will not be considered

• Perform timely clinical adjudication of dental claims and prior authorization requests
• Determine medical necessity and benefit coverage using clinical expertise and plan guidelines
• Interpret radiographs, charts, and supporting documentation to inform decisions
• Identify inappropriate, unnecessary, or low-value services

• Participate in quality improvement initiatives, audits, and utilization analyses
• Conduct focused chart reviews to identify utilization trends and potential quality concerns
• Support SIU activities, including provider site reviews and corrective recommendations
• Analyze treatment patterns and recommend improvements

• Conduct peer-to-peer consultations with network providers
• Participate in grievance, appeal, and secondary review processes
• Collaborate with specialists or subject-matter experts as needed

• Participate in calibration sessions, trainings, and interrater reliability activities
• Attend clinical and operational meetings
• Contribute to credentialing and quality committees
• Support resolution of provider and member concerns

• Provide clinical input during tele-dentistry consultations when needed

• Maintain expertise in dental benefit plans and Medicaid program requirements
• Support regulatory reporting and compliance initiatives

• DDS or DMD from an accredited dental school
• Active, unrestricted dental license in good standing in a U.S. state
• Minimum:
  • 4+ years practicing as a dentist
  • 2+ years experience with claims review, utilization management, or payer-side dentistry preferred
• Strong knowledge of:
  • Dental coding and clinical guidelines
  • Managed care and reimbursement systems
  • Medical necessity criteria and adjudication processes
• Ability to interpret radiographs and dental records
• Strong analytical, decision-making, and communication skills
• Current professional malpractice insurance required (must be maintained throughout the contract period)

• Fully remote, computer-based role
• Work is primarily sedentary and requires extended screen time
• Flexible scheduling aligned with business needs
• 1099 contractor position (no employee benefits)

• You bring a clinical lens to business decisions, balancing quality, cost, and compliance
• You are detail-oriented and consistent in applying guidelines and policies
• You communicate effectively in peer-to-peer provider discussions
• You thrive in a collaborative, healthcare environment

• Fully remote opportunity with flexible scheduling
• Apply your clinical expertise beyond the operatory
• Influence care quality and outcomes at a population level
• Work on meaningful, mission-driven initiatives
• Opportunity for contract extension based on performance and business needs

Submit your resume, licensure details, and proof of current malpractice insurance to be considered for this opportunity.

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.

Sponsorship and Relocation Specifications

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

No relocation assistance or sponsorship available at this time.