New Jersey Licensed Staff Dentist

Job Summary

Seeking a New Jersey Licensed Staff Dentist, the full-time remote position will manage clinical reviews of dental claims and prior authorizations, ensuring compliance with coverage guidelines while collaborating with clinical leaders to improve quality initiatives.

Key responsibilities

• Review dental claims and prior authorization requests to ensure accurate determinations based on coverage guidelines
• Participate in calibration sessions and interrater reliability assessments to maintain clinical consistency
• Conduct peer-to-peer consultations with providers regarding clinical decisions and support grievance and appeal reviews

Required qualifications

• DDS or DMD from an accredited institution
• Active, unrestricted New Jersey dental license in good standing
• Minimum 6 years of experience as a practicing dentist
• Experience with claims review, utilization management, or quality initiatives preferred
• Strong clinical judgment and ability to interpret dental radiographs and clinical records