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Remote Dental Utilization Review Jobs in Michigan

Pharmacy Careers

Appeals Pharmacist (Remote)

Ypsilanti, MI · On-site +1

$51.75 - $63/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Detroit, MI · On-site +1

$52.50 - $63.75/hr

Review clinical documentation for medication coverage appeals and grievances. * Apply evidence ... Prior managed care or utilization management experience preferred - retail and hospital pharmacists ...

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Remote Dental Utilization Review information

What are the key skills and qualifications needed to thrive as a Remote Dental Utilization Review Specialist, and why are they important?

To thrive as a Remote Dental Utilization Review Specialist, you need a solid background in dental hygiene or dentistry, typically supported by a dental degree or RDH license, and experience in clinical or insurance review settings. Familiarity with dental coding systems (such as CDT codes), electronic health records, and utilization review software is crucial. Strong analytical skills, attention to detail, effective communication, and the ability to work independently are standout soft skills for this role. These competencies ensure accurate claim assessments, regulatory compliance, and clear communication between providers, insurers, and patients.

What are the typical challenges faced by a Remote Dental Utilization Review specialist and how can they be managed?

Remote Dental Utilization Review specialists often encounter challenges such as interpreting complex dental claims without direct patient interaction, staying updated with continually evolving dental coding and insurance policies, and effectively communicating findings with both providers and insurance teams. Managing these challenges requires strong attention to detail, continuous professional development through training, and leveraging secure digital communication tools to collaborate with other team members. Building organizational skills and seeking feedback from peers can also help in efficiently handling a high volume of cases while maintaining accuracy.

What is a Remote Dental Utilization Review job?

A Remote Dental Utilization Review job involves evaluating dental claims and treatment plans submitted by dentists to ensure that they are necessary, appropriate, and in line with insurance policies and clinical guidelines. Professionals in this role, often dental hygienists or dentists, work from home to review documentation and make determinations about coverage or reimbursement. They may also communicate with providers for additional information and help prevent fraud or unnecessary procedures. This job requires knowledge of dental terminology, insurance processes, and strong attention to detail.

What is the difference between Remote Dental Utilization Review vs Remote Dental Claims Examiner?

AspectRemote Dental Utilization ReviewRemote Dental Claims Examiner
CredentialsDental background, certifications in utilization reviewDental coding, claims processing certifications
Work EnvironmentRemote, review-focusedRemote, claims processing
Industry UsageInsurance companies, healthcare providersInsurance companies, third-party administrators

Remote Dental Utilization Review professionals focus on evaluating the necessity and appropriateness of dental services, often requiring clinical knowledge and utilization review certifications. In contrast, Remote Dental Claims Examiners primarily process and adjudicate dental insurance claims, emphasizing coding and claims knowledge. Both roles are remote and serve the dental insurance industry, but their core responsibilities and required credentials differ.

What are the most commonly searched types of Dental Utilization Review jobs in Michigan? The most popular types of Dental Utilization Review jobs in Michigan are:
What are popular job titles related to Remote Dental Utilization Review jobs in Michigan? For Remote Dental Utilization Review jobs in Michigan, the most frequently searched job titles are:
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What cities in Michigan are hiring for Remote Dental Utilization Review jobs? Cities in Michigan with the most Remote Dental Utilization Review job openings:
Remote Dental Utilization Review jobs near you
Utilization Review Medical Director

Utilization Review Medical Director

Integra Partners

Troy, MI • On-site, Remote

$250K - $250K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 27 days ago

Job 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. This role is best suited for physicians who thrive in a process-driven environment and are committed to consistency, compliance, and evidence-based decision making.
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 and maintain continuous case throughput in alignment with organizational turnaround and productivity standards.
  • Evaluate clinical documentation, identify missing elements, and render determinations supported by clear clinical rationale.
  • Review cases escalated by UM staff and/or UM Leadership when criteria do not apply to the enrollee's unique clinical situation or when clinical judgment is required.
  • When appropriate, consult with external board-certified reviewers, engage with ordering practitioners, or conduct additional clinical dialogue prior to rendering a determination.
  • Participate in Peer-to-Peer (P2P) discussions, including maintaining availability for scheduled appointment times.
  • Document all clinical decisions clearly, concisely, and consistently in accordance with internal SOPs, NCQA standards, and regulatory expectations.
  • Maintain inter-rater reliability and participate in periodic calibration reviews to support consistency across the UM program.
  • Serve as a clinical resource for UM team, providing guidance on clinical interpretation, criteria application, and complex case review.
  • Support internal and external audit activities as needed, including NCQA accreditation, health plan audits, and state Medicaid reviews.
  • Notify leadership of observed trends, potential quality concerns, or opportunities to strengthen criteria alignment or operational workflows.
  • Maintain up-to-date knowledge of Medicare, Medicaid, DMEPOS policies, clinical standards of care, and regulatory updates relevant to UM.
Requirements:
  • MD or DO degree
  • 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

Working Conditions and Additional Expectations:
  • Full-time remote role requiring consistent availability during standard business hours and responsiveness to daily assignments.
  • Case volume and mix vary; continuous throughput and timely review completion are required.
  • Must maintain a quiet, secure, and compliant environment for reviewing PHI and participating in P2P calls.
  • Secondary employment or consulting arrangements are permitted only if they do not interfere with the full-time expectations and require disclosure/approval.
  • Daily accountability measures, productivity monitoring, and adherence to all UM workflows are required.

Salary: $250,000.00/annually
Benefits Offered
  • Competitive compensation and 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

Remote Opportunities
We are actively seeking new colleagues in: Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kentucky, Massachusetts, Michigan, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.
Our Story
Founded in 2005, Integra Partners is a leading national durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) network administrator. Our mission is to improve the quality of life for the communities we serve by reimagining access to in-home healthcare. We connect Payers, Providers, and Members through innovative technology and streamlined workflows affording Members access to top local Providers and culturally competent care. By focusing on transparency, accountability, and adaptability, we help deliver better health outcomes and more efficient management of complex healthcare benefits. Integra Partners is a wholly owned subsidiary of Point32Health.
With a location in Michigan plus a remote workforce across the United States, Integra has a culture focused on collaboration, teamwork, and our values: One Team, Drive Results, Push the Boundaries, Value Others, and Build Community. We're looking for energetic, talented, and dedicated individuals to join our team. See what opportunities we have available; there may be a role for you to engage in a challenging yet rewarding career in healthcare. We look forward to learning more about you.
Integra Partners is an equal opportunity employer. We are committed to providing reasonable accommodations and will work with you to meet your needs. If you are a person with a disability and require assistance during the application process, please don't hesitate to reach out. We celebrate our inclusive work environment and welcome members of all backgrounds and perspectives.

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