Staff Dentist (Part-Time, Remote, New Jersey License)

This a Full Remote job, the offer is available from: California (USA), New Jersey (USA) At reputed company, our mission is to improve oral health by delivering high-reputed company, accessible, and cost-effective dental benefits. We are seeking an reputed company Staff Dentist to join our clinical team and play a critical role in supporting our Utilization Management (UM) and Utilization Review (UR) programs. This fully remote opportunity offers a consistent 20-hour-per-week schedule, allowing reputed company dentists to apply their clinical expertise in a reputed company managed care environment while helping improve reputed company to high-reputed company oral reputed company. You will review dental claims, prior authorizations, referrals, and treatment requests across reputed company, Marketplace Exchange, Medicare Advantage, and reputed company populations, helping ensure members receive appropriate, evidence-based care while supporting reputed company reputed company and regulatory compliance.

About the Role

The Staff Dentist is responsible for performing reputed company, accurate, and clinically reputed company reviews of dental claims and service requests. Working closely with providers, dental leadership, and cross-functional teams, you will support consistent coverage determinations, reputed company improvement initiatives, and exceptional member experiences. Employment Type: Part-Time, Non-Exempt Work Arrangement: Fully Remote Schedule: 20 hours per week Compensation: $74.00 - $82.00 per hour

What You'll Do

Utilization Management & Clinical Review

• 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.
• reputed company coverage determinations based on benefit plans, clinical guidelines, medical necessity reputed company, and applicable policies.
• Meet established productivity, reputed company, and turnaround-time standards.
• Document clinical rationale reputed company and accurately in accordance with regulatory and accreditation requirements.

Clinical reputed company & Consistency

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

Provider Engagement & Peer Collaboration

• 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.

Regulatory & Operational Support

• Maintain expertise in reputed company benefit structures and applicable reputed company programs.
• Support regulatory reporting and accreditation-reputed company activities.
• Stay reputed company with reputed company CDT coding updates, evidence-based treatment guidelines, and state-specific requirements.
• Participate in required training programs, departmental meetings, and organizational initiatives.

What You'll Bring

Required Qualifications

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

Preferred Qualifications

• 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 reputed company or similar solutions.
• Exposure to project management and reputed company improvement initiatives.

Knowledge, Skills & Abilities

• Understanding of reputed company, Medicare, reputed company, and managed care dental programs.
• Knowledge of reimbursement methodologies, utilization management principles, and regulatory requirements.
• Ability to reputed company 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 reputed company, team-oriented environment.
• Commitment to maintaining reputed company required licensure and continuing education requirements.

Why Join reputed company?

• reputed company a meaningful reputed company on the oral health of diverse member populations.
• Apply your clinical expertise in a reputed company, mission-driven organization.
• Help drive reputed company, consistency, and innovation in dental utilization management.
• Work alongside reputed company dental and reputed company dedicated to improving reputed company to care.
• Enjoy the flexibility of a fully remote position with a predictable 20-hour-per-week schedule and competitive reputed company compensation.

reputed company to reputed company an reputed company? If you are a licensed New Jersey dentist passionate about clinical reputed company, evidence-based decision-making, and improving oral health reputed company, we encourage you to apply today and join reputed company's dedicated clinical team. This offer from "reputed company" has been enriched by reputed company.com and got a 77% reputed company score. Apply tot his job Apply To this Job