Remote Utilization Review Medical Director - DMEPOS Expert

Remote Genie; Northern (KY); Hybrid; USD 281,000 - 343,000; Full time

Benefits offered by this job

401(k) retirement program with company

Company-paid life insurance

Company-paid short term disability

Medical, Vision, and Dental benefits

Paid Time Off

Sick Time

Paid holidays and floating holidays

Quarterly company-sponsored events

Health and wellness programs

Job summary

Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast-paced, real-time queue.

This full-time role emphasizes accuracy, compliance, and evidence-based decision making. Qualifications include MD/DO, board certification in Internal Medicine, Family Medicine, or PM&R, and UM/NCQA

Qualifications

• MD or DO degree required and board-certified in one of the specified specialties.
• Experience with utilization management or clinical review.
• Strong documentation and communication skills.
• Ability to work in high-volume queue-based workflow.

Responsibilities

• Conduct timely clinical reviews of DMEPOS requests using applicable criteria.
• Maintain real-time review queue and throughput.
• Evaluate documentation and render determinations with rationale.
• Review escalated cases and consult with external reviewers when needed.
• Document decisions per NCQA standards and internal policies.
• Support audits and accreditation activities.

Skills

Communication skills

UM workflow experience

DMEPOS experience

NCQA accreditation experience

Education

MD or DO degree

Board certification in Internal Medicine

Board certification in Family Medicine

Board certification in Physical Medicine & Rehabilitation

Tools

Electronic UM systems

Authorization platforms

Job description

Integra Partners, a national DMEPOS network administrator, seeks a remote Utilization Review Medical Director. You will conduct clinical reviews of DMEPOS requests, ensure determinations meet Medicare/Medicaid guidelines, and maintain high-quality documentation in a fast-paced, real-time queue.

This full-time role emphasizes accuracy, compliance, and evidence-based decision making. Qualifications include MD/DO, board certification in Internal Medicine, Family Medicine, or PM&R, and UM/NCQA