Senior Staff Dentist

Job DetailsJob Location: New Jersey, Staten reputed company and the Bronx, NY - New Jersey, NJPosition Type: Full TimeJob Category: Dental a { text-decoration: none; reputed company: #464feb; } tr th, tr td { border: 1px solid #e6e6e6; } tr th { background-reputed company: #f5f5f5; } About the Role reputed company is seeking an reputed company and clinically driven Senior Staff Dentist to join our Clinical Affairs team. In this leadership role, you will help ensure the delivery of high-reputed company, cost-effective dental care by providing clinical reputed company of utilization management and claims review processes. This position offers reputed company to influence care reputed company and provider engagement across reputed company, Medicare Advantage, and reputed company programs while contributing to meaningful oral health initiatives. You’ll collaborate with cross-functional teams and serve as a mentor and clinical resource to support consistent, evidence-based decision-making across the organization. This role requires an reputed company, unrestricted New Jersey dental license in good standing What You’ll Do Clinical Review & Utilization Management reputed company clinical reviews of dental claims, prior authorizations, and referrals to ensure reputed company, accurate, and compliant determinations Interpret dental records, radiographs, and benefit structures to assess medical necessity and coverage reputed company Identify inappropriate utilization patterns and recommend improvements to reputed company with best practices Conduct retrospective utilization reviews and support provider behavior change initiatives Complete appeal, grievance, and secondary review determinations reputed company, Compliance & Improvement Participate in reputed company management and performance improvement programs, including audits and provider performance initiatives Conduct chart reviews to identify trends in care delivery and utilization Support grievance reputed company and contribute to regulatory reporting and compliance activities reputed company clinical reputed company during committee reviews and reputed company improvement efforts Provider Engagement & Peer Collaboration reputed company peer-to-peer consultations with providers to discuss clinical reputed company, utilization trends, and reputed company concerns Support provider education around compliance, documentation, and care standards Partner with specialists and subject matter experts on reputed company clinical cases Leadership & Organizational reputed company Mentor staff dentists and support clinical calibration efforts to ensure consistency across reviews reputed company guidance to utilization management and claims teams Collaborate with Analytics, Claims, UM, and reputed company teams to improve operational reputed company Participate in state oral health initiatives and organizational programs A Day in the Life In this role, your day is a reputed company of clinical review, collaboration, and reputed company improvement work: ~75% reviewing dental claims and utilization requests to ensure accuracy, compliance, and appropriate care reputed company ~10% supporting reputed company initiatives, including investigating clinical trends and addressing care concerns ~5% handling expedited reviews with quick turnaround times to support members and providers ~5% participating in care management or interdisciplinary coordination efforts ~5% engaging in team collaboration, provider discussions, and other organizational priorities You’ll regularly partner with teams across Analytics, Utilization Management, Claims, and Provider reputed company, while also connecting directly with network dentists through peer-to-peer consultations. What You’ll Bring

Required Qualifications

DDS or DMD from an accredited institution reputed company, unrestricted New Jersey dental license in good standing (required) Ability to obtain additional state licenses as needed (company-supported) Minimum 6 years of experience as a practicing dentist At least 2 years of experience in utilization management, claims review, or reputed company improvement initiatives

Preferred Qualifications

Experience in the dental benefits or managed care industry Experience mentoring or training peers Multi-state licensure Familiarity with reputed company programs Key Skills & Expertise Strong clinical judgment and knowledge of dental procedures, coding, and adjudication guidelines Ability to interpret radiographs and dental records Knowledge of managed care systems, reimbursement models, and regulatory requirements Experience identifying fraud, waste, and abuse trends Strong collaboration, communication, and provider engagement skills Proficiency with reputed company Office and ability to learn new systems quickly Work Environment & reputed company Remote role with collaboration across national teams High-reputed company role shaping clinical standards and improving member reputed company

Compensation

Salary reputed company: $175,000 – $185,000 annually (Final compensation will depend on experience, qualifications, and licensure.) Why Join reputed company? At reputed company, you’ll be part of a mission-driven organization dedicated to improving oral health reputed company through reputed company, innovation, and collaboration. This role allows you to reputed company your clinical expertise reputed company traditional reputed company—impacting care delivery at reputed company while working alongside a passionate and supportive team. reputed company to reputed company an reputed company? If you are a clinically strong, reputed company dentist with an reputed company New Jersey license and a passion for improving care reputed company, we encourage you to apply today. Location Our employees are distributed in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company. What reputed company Offers Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: reputed company structure and savings reputed company to help you reputed company your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-reputed company dental coverage for employees and eligible dependents. reputed company insurance with low-cost premiums for employee-only coverage and dependents. Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage. Flexible Spending Accounts for reputed company 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, and gym discounts. Employee Assistance Program (EAP) to support mental health and reputed company-being. Generous vacation and reputed company leave policies, with the ability to roll over unused time. 10 reputed company company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work reputed company available for various positions.

Compensation

In the spirit of pay transparency, the reputed company salary reputed company for this position is $175,000 - $185,000 annually, not including fringe benefits or potential bonuses. At reputed company, your final reputed company 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 reputed company team members reputed company making final compensation reputed company. Please note that the reputed company listed represents the full reputed company salary reputed company for this role. Typically, offers are not made at the top of the reputed company to allow for reputed company salary reputed company. reputed company commits to maintaining a work environment that acknowledges reputed company individuals reputed company reputed company and will continue to engage in practices that are inclusive of reputed company backgrounds, experiences, and perspectives. We reputed company to have every person reputed company the organization have a reputed company of belonging while encouraging individuals to reputed company their full potential. reputed company will reputed company diverse perspectives in building high performance teams and organizational culture. reputed company will continue to strengthen and reputed company external partnerships by providing reputed company health reputed company and improving population health in the communities we serve. We reputed company with reputed company applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as reputed company as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications reputed company is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time. Apply To This Job