Utilization Review Medical Director
Position Summary
- Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a salaried, 40+ hour per week position expected to be your primary professional responsibility. The role requires daily participation in a structured authorization review queue and close adherence to workflow timelines and productivity standards.
- This role is best suited for candidates who are focused, responsive, and comfortable working in a high-volume, process-driven environment with a strong commitment to clinical accuracy, compliance, and consistency.
Job Responsibilities:
- Conducting timely clinical review of Durable Medical Equipment (DME) requests in alignment with Medicare/Medicaid guidelines, state-specific, and health plan criteria.
- Function within a daily review queue, processing cases throughout the day as part of routine operations.
- Evaluate clinical documentation provided and render determinations based on applicable criteria (i.e. LCD, InterQual, NY Medicaid Manual, Internal policies, member handbooks)
- Upon an enrollee’s individual situation or the local delivery system rendering the criteria inappropriate, the Utilization Management Nurse will route the case to the UR Medical Director. The UR Medical Director will review the case and may consult with board certified external reviewers and/or discuss the case with the ordering practitioner before rendering a determination.
- Participate in Peer to Peer (P2P) appointments for live discussions with requesting and servicing providers, including being available at appointment times
- Maintain clear, complete, and accurate documentation of all reviews and clinical decisions in alignment with internal SOPs and regulatory expectations.
- Adhere to health plan inter-rater reliability standards and participate in periodic review calibration
- Serve as a clinical resource and subject matter expert for the utilization management team.
- MD or DO Required
- Board-certified in Internal Medicine, Family Medicine or Physical Medicine & Rehabilitation
- No current or past OIG or state sanctions; eligible for participation in Medicare, Medicaid, and other federally funded programs.
- Experience with NCQA accreditation
- Excellent written and verbal communication skills, with strong attention to documentation accuracy
- Professionalism and responsiveness in handling requests
- Familiarity with electronic UM systems and queue-based case management preferred
- Analytical ability and clinical knowledge to identify trends and report findings
- Interpersonal skills necessary to develop and maintain a wide variety of cooperative working relationships
- Experience performing UM activities for MLTC, Medicaid and/or Medicare Advantage Plans preferred
- DMEPOS experience preferred
Working Conditions and Additional Expectations:
- This is a remote full-time position, but requires consistent availability during standard business hours and responsiveness to daily work assignments
- The role is structured around a real-time, case-by-case review queue. Review volume and case mix may vary but continuous throughput is expected
- Candidate must have reliable internet connectivity and a quiet, secure environment for handling PHI and confidential materials.
- This is not a per diem or part-time review role
- Secondary employment or consulting arrangements that interfere with the full-time expectations of this role are not permitted.
- Role requires daily accountability, productivity monitoring, and adherence to workflow timelines
Benefits Offered
- Competitive compensation and annual bonus program
- 401(k) retirement program with company match
- Company-paid life insurance
- Company-paid short term disability coverage (location restrictions may apply)
- Medical, Vision, and Dental benefits
- Paid Time Off (PTO)
- Paid Parental Leave
- Sick Time
- Paid company holidays and floating holidays
- Quarterly company-sponsored events
- Health and wellness programs
- Career development opportunities
Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We’re looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don’t hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.