SummaryGainwell Technologies is seeking a
Medical Reviewer (Physical Therapist) to provide clinical expertise supporting Medical Review Services for California healthcare programs. In this role, you will review therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation to help ensure services meet applicable clinical, coverage, and program requirements.
Your role in our mission- Review physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation.
- Evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements.
- Apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations.
- Review treatment plans and supporting documentation for requested services.
- Document review findings and clinical rationale accurately and timely.
- Refer cases requiring additional clinical review to appropriate medical professionals when needed.
- Collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to resolve review questions.
- Maintain knowledge of applicable physical therapy standards, medical policies, coverage requirements, and regulatory guidelines.
- Meet established quality, accuracy, productivity, and turnaround-time expectations.
What we're looking for- Minimum of three (3) years of experience as a Physical Therapist.
- Graduation from an accredited school of Physical Therapy.
- California license to practice Physical Therapy, or eligibility for California licensure.
- Current professional certification in good standing.
- Strong clinical judgment and ability to interpret medical records, treatment plans, and therapy-related documentation.
- Strong written and verbal communication skills.
- Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.
What you should expect in this role- Full-time position.
- Remote work environment.
- Monday through Friday work schedule.
- Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
- Spend the majority of your day reviewing physical therapy-related medical, clinical, claim, authorization, treatment plan, and supporting documentation.
- Work independently while collaborating with physicians, nurses, therapists, other clinical specialists, operations teams, and business partners.
- Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
- Maintain all professional licenses, certifications, and credentials required for the position in active and good-standing status, as applicable.
- Maintain knowledge of applicable medical policies, coverage requirements, physical therapy standards, and regulatory guidelines.
- Meet established quality, accuracy, productivity, and turnaround-time expectations.
- Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.
- Travel requirement: 0-10%.
This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.#LI-REMOTE
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The pay range for this position is $85,000 - $100,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
