Remote Utilization Review Medical Director

Integra Partners; Troy (MI); On-site; USD 170,000 - 243,000; Full time

Benefits offered by this job

Competitive compensation

401(k) with company match

Medical, Vision, and Dental benefits

Paid Time Off

Parental Leave

Sick Time

Holidays and floating holidays

Career development opportunities

Job summary

Integra Partners is seeking a Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a high-volume UM environment. The role emphasizes evidence-based decision making, adherence to Medicare/Medicaid guidelines, and regulatory requirements.

The position requires MD/DO with board certification in Internal/Family Medicine or PM&R, and experience in utilization management. Remote work during standard business hours is supported, with opportunities to contribute to

Qualifications

• MD or DO degree required; board certification in Internal Medicine, Family Medicine, or PM&R preferred.
• Experience performing utilization management or clinical review activities.
• Strong written and verbal communication with documentation accuracy.
• Able to work in high-volume, queue-based workflow and adhere to UM processes.
• Familiarity with DMEPOS reviews and NCQA UM accreditation standards.

Responsibilities

• Conduct timely clinical reviews of DMEPOS authorization requests using LCDs, Medicaid Manuals, InterQual, MCG, internal policies, and health plan requirements.
• Maintain continuous throughput in a real-time review queue in line with turnaround targets.
• Evaluate clinical documentation and render determinations with clear clinical rationale.
• Review cases escalated by UM staff or leadership when criteria don’t apply universally.
• Participate in Peer-to-Peer discussions and be available for scheduled times.
• Document decisions clearly per SOPs and NCQA standards; support audits and calibration reviews.
• Provide clinical guidance on interpretation of criteria and complex cases.

Skills

Communication skills

Clinical decision making

Time management

Education

MD or DO degree

Board certification in Internal/Family/PM&R

Eligible for Medicare/Medicaid participation

UM utilization management experience

Tools

InterQual

MCG

LCDs

Medicaid Manuals

Internal policies

NCQA UM standards

Job description

Integra Partners is seeking a Utilization Review Medical Director to lead clinical reviews of DMEPOS requests within a high-volume UM environment. The role emphasizes evidence-based decision making, adherence to Medicare/Medicaid guidelines, and regulatory requirements.

The position requires MD/DO with board certification in Internal/Family Medicine or PM&R, and experience in utilization management. Remote work during standard business hours is supported, with opportunities to contribute to