California Licensed Senior Dentist

Job Summary

Seeking a highly experienced California Licensed Senior Dentist for a full-time remote position, who will provide clinical leadership in Utilization Management and Review programs, focusing on reviewing claims, ensuring compliance, and improving care quality for diverse populations, particularly within California Medicaid.

Key Responsibilities

• Review dental claims and prior authorization requests to ensure medical necessity and compliance
• Conduct quality improvement initiatives and participate in regulatory reporting and chart audits
• Engage with network providers through peer consultations to enhance documentation and care quality

Required Qualifications

• DDS or DMD degree
• Active, unrestricted California dental license
• Minimum 6 years of experience as a practicing dentist
• At least 2 years of experience in utilization management or claims review
• Strong clinical judgment with the ability to interpret dental radiographs and patient records