Location
Troy
Job Type
Full-time
Posted
June 20, 2026
Job Description
Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant UM program.
Salary: $60,000.00/annual
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The UM Nurse’s responsibilities include but are not limited to:
+ Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit language and NCDs/LCDs as criteria for medical necessity reviews
+ Work with non-clinical team to obtain additional clinical information, as needed
+ Approve requests that meet eligibility, benefit, and medical necessity criteria
+ Refer cases to the Medical Director that do not meet medical necessity criteria
+ Refer cases to in...
Salary: $60,000.00/annual
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES
The UM Nurse’s responsibilities include but are not limited to:
+ Perform pre-service and post service UM authorization reviews utilizing federal and state mandates, plan benefit language and NCDs/LCDs as criteria for medical necessity reviews
+ Work with non-clinical team to obtain additional clinical information, as needed
+ Approve requests that meet eligibility, benefit, and medical necessity criteria
+ Refer cases to the Medical Director that do not meet medical necessity criteria
+ Refer cases to in...
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