Utilization Review Medical Director

The Utilization Review Medical Director conducts clinical reviews of DME and related requests to support Integra's Utilization Management operations. The role is responsible for determinations in accordance with Medicare and Medicaid guidelines, health plan-specific criteria, internal policies, and regulatory requirements.

Requirements

• MD or DO degree
• The ability to obtain a New York state medical license and any additional state licenses as needed
• Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
• Eligible for participation in Medicare, Medicaid, and other federally funded programs; no current or past OIG or state sanctions
• Experience performing utilization management or clinical review activities
• Strong written and verbal communication skills with emphasis on documentation accuracy
• Ability to work effectively in a high-volume, queue-based workflow with daily review expectations
• Familiarity with electronic UM systems and authorization platforms
• Experience with DMEPOS reviews
• Experience with NCQA UM accreditation standards
• Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans

Benefits

• Competitive compensation
• 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