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Remote Medicaid Jobs in Rochester, MI (NOW HIRING)

Amerihealth Caritas

Supv Prov Net Ops

Southfield, MI · Remote

$77K - $104K/yr

Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend ... Familiarity with Medicaid reimbursement methodologies preferred Skills & Abilities: * Strong ...

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All JobsMedicaid JobsRemote Medicaid JobsRemote Medicaid Jobs in Rochester, MI

Remote Medicaid information

See Rochester, MI salary details

$14

$25

$38

How much do remote medicaid jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for remote medicaid in Rochester, MI is $25.63, according to ZipRecruiter salary data. Most workers in this role earn between $15.91 and $30.10 per hour, depending on experience, location, and employer.

What is a remote Medicaid?

A Remote Medicaid job involves working from home to assist with Medicaid-related tasks such as processing applications, verifying eligibility, providing customer support, or managing claims. These roles can be in healthcare organizations, government agencies, or insurance companies. Responsibilities may include data entry, policy compliance, and assisting beneficiaries with their Medicaid coverage.

What are the typical daily responsibilities of a remote Medicaid?

In a Remote Medicaid position, you can expect to review and process Medicaid applications, verify eligibility, and communicate with clients or healthcare providers to gather necessary documentation. The role often involves handling sensitive client information, conducting case management tasks, and ensuring compliance with federal and state Medicaid guidelines. You may also coordinate with other team members, such as social workers, nurses, or billing specialists, using virtual collaboration tools. This remote setup allows you to manage caseloads efficiently while maintaining ongoing communication with both clients and your support team.

What are the key skills and qualifications needed to thrive in remote Medicaid, and why are they important?

To thrive in a Remote Medicaid role, you typically need knowledge of Medicaid eligibility and policy, strong organizational skills, and relevant experience in healthcare administration or case management. Familiarity with Medicaid Management Information Systems (MMIS), electronic health records (EHR), and secure telehealth platforms is highly valuable, and some positions may require certification in medical billing or coding. Outstanding attention to detail, excellent verbal and written communication, and the ability to work independently in a remote environment are crucial soft skills. These abilities ensure accurate case handling, regulatory compliance, and efficient service delivery to vulnerable populations from a distance.

What are popular job titles related to Remote Medicaid jobs in Rochester, MI?

For Remote Medicaid jobs in Rochester, MI, the most frequently searched job titles are:

What job categories do people searching Remote Medicaid jobs in Rochester, MI look for?

The top searched job categories for Remote Medicaid jobs in Rochester, MI are:

What cities near Rochester, MI are hiring for Remote Medicaid jobs?

Cities near Rochester, MI with the most Remote Medicaid job openings:

Remote Medicaid jobs near you
Infographic showing various Remote Medicaid job openings in Rochester, MI as of August 2026, with employment types broken down into 2% As Needed, 80% Full Time, 14% Part Time, 3% Contract, and 1% Nights. Highlights an 85% Physical, 2% Hybrid, and 13% Remote job distribution, with an average salary of $53,314 per year, or $25.6 per hour.

Utilization Review Medical Director (Contract)

Troy, MI • Remote

Integra Partners
Health Care and Social Assistance • 201 - 500 employees
Learn more about Integra Partnersexternal

$150/hr

Part-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 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. 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:
  • 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: $150.00/Hourly 
 

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.

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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