Utilization Review Medical Director - Troy - Integra Partners

    Integra Partners
    Integra Partners Troy

    22 hours ago

    Description

    The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations.

    This full-time, salaried role functions within a structured, high-volume authorization review queue and requires adherence to workflow timelines, clinical accuracy standards, and productivity expectations.

    The Medical Director ensures determinations are made in accordance with Medicare and Medicaid guidelines, health plan–specific criteria, internal policies, and regulatory requirements.

    The Utilization Review Medical Director's responsibilities include but are not limited to:

    • Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria including LCDs Medicaid Manuals InterQual MCG internal medical policies  and health plan requirements.
    • Function within a real-time review queue maintain continuous case throughput in alignment with organizational turnaround productivity standards.
    • evaluate clinical documentation identify missing elements render determinations supported by clear clinical rationale.

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    · The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions within a structured, high-volume ...

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