SummaryGainwell Technologies is seeking a
Medical Reviewer (Podiatrist) to provide professional podiatric expertise supporting Medical Review Services for California healthcare programs. In this role, you will review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation to help ensure services meet applicable clinical, coverage, and program requirements.
Your role in our mission- Review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation.
- Evaluate requested podiatric services against applicable coverage requirements, medical policies, and clinical standards.
- Apply professional podiatric expertise and clinical judgment when reviewing medical necessity and appropriateness of services.
- Review treatment plans and supporting documentation for requested services.
- Document clinical findings, review decisions, and supporting rationale accurately and timely.
- Refer cases requiring additional clinical review to appropriate medical professionals when needed.
- Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions.
- Maintain knowledge of applicable podiatric standards, medical policies, coverage requirements, and regulatory guidelines.
- Meet established quality, accuracy, productivity, and turnaround-time expectations.
What we're looking for- One (1) year of experience working in a variety of clinical settings, ranging from general podiatry services to working with a multi-professional team, is preferred.
- Doctorate or Diploma in Podiatric Medicine, or Diploma in Chiropody.
- Current California State license to practice Podiatry, in good standing.
- Strong clinical judgment and ability to interpret medical records, treatment plans, and supporting clinical documentation.
- Ability to work effectively with multidisciplinary healthcare teams.
- Strong written and verbal communication skills.
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 podiatry-related medical, clinical, claim, authorization, treatment plan, and supporting documentation.
- Work independently while collaborating with physicians, nurses, 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, unrestricted, and good-standing status, as applicable.
- Maintain knowledge of applicable medical policies, coverage requirements, podiatric 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
#LI-MA1
The pay range for this position is $110,000 - $130,000 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.
