Remote DMEPOS Utilization Review Medical Director

Integra Partners; Northern (KY); Hybrid; USD 176,000 - 237,000; Full time

Benefits offered by this job

Competitive compensation

401(k) with company match

Medical, Vision, and Dental benefits

PTO and sick time

Parental leave

Bonuses

Job summary

Integra Partners seeks an experienced Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a remote UM environment. You will ensure decisions meet Medicare/Medicaid guidelines and internal policies while maintaining timely throughput and documented rationale.

Qualifications include MD/DO with board certification (IM/FM/PM&R), and proven UM experience. Strong communication, audit support, and familiarity with NCQA standards are required for this role.

Qualifications

• MD/DO required with board certification in IM, FM, or PM&R.
• Eligible for Medicare/Medicaid participation; no sanctions.
• Experience with utilization management or clinical reviews is essential.
• Excellent documentation and communication skills are required.
• Ability to work in a high-volume, queue-driven workflow and adhere to timelines.

Responsibilities

• Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria (LCDs, Medicaid manuals, InterQual, MCG, internal policies).
• Maintain real-time throughput in line with productivity standards.
• Evaluate documentation and render determinations with clear rationale.
• Review escalated cases and consult with external reviewers when needed.
• Engage in Peer-to-Peer discussions and document decisions per SOPs and regulatory standards.
• Support audits and NCQA accreditation activities as required.

Skills

Utilization management experience

Clinical documentation

Strong written and verbal沟通

Education

MD or DO degree

Board certification in Internal Medicine or Family Medicine or Physical Medicine & Rehabilitation

Tools

Electronic UM systems

NCQA UM accreditation standards

DMEPOS reviews

Job description

Integra Partners seeks an experienced Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a remote UM environment. You will ensure decisions meet Medicare/Medicaid guidelines and internal policies while maintaining timely throughput and documented rationale.

Qualifications include MD/DO with board certification (IM/FM/PM&R), and proven UM experience. Strong communication, audit support, and familiarity with NCQA standards are required for this role.