California Licensed Staff Dentist

Job Summary

To support Utilization Management and Review functions, the fully remote California Licensed Staff Dentist (1099 Independent Contractor) will perform clinical reviews of claims, prior authorizations, and referrals, ensuring regulatory compliance and high-quality oral health outcomes over a 6-month assignment.

Key Responsibilities

• Perform clinical adjudication of dental claims and prior authorization requests, determining medical necessity and benefit coverage
• Participate in quality improvement initiatives and conduct focused chart reviews to identify utilization trends and quality concerns
• Engage in peer-to-peer consultations with network providers and support grievance, appeal, and secondary review processes

Required Qualifications

• DDS or DMD from an accredited dental school
• Active, unrestricted dental license in good standing in California or New Jersey
• Minimum of 4 years practicing as a dentist
• 2+ years of experience with claims review or utilization management preferred
• Strong knowledge of dental coding, clinical guidelines, and managed care systems