Durable Medical Equipment Consultant
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.
- 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.
- 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