Durable Medical Equipment Consultant [Remote]

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Durable Medical Equipment Consultant based in the United States.

This role plays a critical part in ensuring Medicaid Durable Medical Equipment (DME) requests are reviewed accurately, consistently, and in alignment with state policy and clinical guidelines.
You will serve as a subject matter expert supporting prior authorization reviews, helping ensure appropriate medical necessity determinations across complex cases.
The position involves working within a highly regulated healthcare environment where accuracy, compliance, and clinical judgment are essential.
You will collaborate with internal teams and external providers to clarify documentation, support decision-making, and improve authorization workflows.
This is a non-patient-facing role focused on clinical review, policy interpretation, and operational support.
It offers the opportunity to contribute to healthcare system efficiency while working in a structured yet flexible remote setting.
The role is ideal for professionals who enjoy combining clinical expertise with analytical and administrative decision-making.

Accountabilities:

• Review and adjudicate Durable Medical Equipment (DME) prior authorization requests to determine medical necessity and eligibility in accordance with Medicaid state policies and clinical guidelines.
• Evaluate submitted documentation using multiple systems, requesting additional information or clarification from providers when needed to support accurate determinations.
• Enter prior authorization decisions into Medicaid Management Information Systems (MMIS) to ensure timely and accurate processing.
• Act as a clinical subject matter expert and liaison, supporting internal teams and external providers with guidance on DME-related inquiries and submissions.
• Participate in operational and stakeholder meetings with leadership, clinical peers, and state representatives to support program alignment and improvements.
• Contribute insights and recommendations to improve processes, efficiency, and policy application within the Medicaid DME program.
• Review and support provider communications related to policy updates, changes, and procedural guidance.

Requirements:

• Active Occupational Therapy, Physical Therapy, or Registered Nurse (RN) license in Wisconsin, or active license in another state with eligibility to obtain Wisconsin licensure before start date.
• Extensive experience in Durable Medical Equipment (DME), including provision, delivery, coding, pricing, and utilization practices.
• Familiarity with Medicaid programs (Wisconsin Medicaid preferred, or other state Medicaid experience acceptable).
• Strong understanding of clinical documentation review and medical necessity determination processes.
• Excellent written, verbal, and interpersonal communication skills with the ability to interact effectively with providers and internal stakeholders.
• Ability to manage deadlines and multiple priorities with minimal supervision in a structured regulatory environment.
• Strong analytical thinking and attention to detail, particularly when reviewing clinical and technical documentation.
• Collaborative mindset with experience working across multidisciplinary teams and stakeholders.
• High level of professionalism, accountability, and adaptability in a fast-paced healthcare operations setting.

Benefits:

• Competitive annual salary range: $64,500 – $92,200 (based on experience and location)
• Remote work flexibility within the United States
• Flexible vacation policy and work-life balance support
• Comprehensive health, dental, and vision insurance coverage
• 401(k) retirement plan with employer match
• Tuition and educational assistance programs
• Access to leadership and technical development academies
• Career growth opportunities within a structured healthcare organization
• Collaborative and mission-driven work environment focused on improving healthcare systems

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.