Utilization Review Medical Director

Job Summary

Utilization Review Medical Director is a full-time, salaried position responsible for conducting clinical reviews of Durable Medical Equipment (DME) requests to support Utilization Management operations in a remote setting.

Key Responsibilities

• Conduct timely clinical reviews of DMEPOS authorization requests using applicable criteria
• Maintain continuous case throughput in alignment with organizational turnaround and productivity standards
• Document all clinical decisions clearly and participate in Peer-to-Peer discussions as needed

Required Qualifications

• MD or DO degree
• Board certification in Internal Medicine, Family Medicine, or Physical Medicine & Rehabilitation
• Experience performing utilization management or clinical review activities
• Familiarity with electronic UM systems and authorization platforms
• Prior UM experience for MLTC, Medicaid, or Medicare Advantage plans