Utilization Review Medical Director

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