SummaryGainwell Technologies is seeking a
Medical Reviewer (Speech and Audiology Specialist) to provide subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation to help ensure services meet applicable medical necessity, coverage, and program requirements.
Your role in our mission- Review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation.
- Evaluate requested services based on applicable medical policies, coverage requirements, and professional standards.
- Apply speech-language pathology or audiology expertise to support medical necessity and appropriateness determinations.
- Review treatment plans and supporting documentation for requested or billed services.
- Document review findings, decisions, and supporting clinical 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 professional 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 Speech, Language, or Audiology practitioner.
- Current California professional credentials as applicable to the discipline.
- Current Certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech-Language-Hearing Association, consistent with applicable program requirements.
- Strong oral and written communication skills.
- Strong clinical judgment and ability to interpret clinical records, treatment plans, and supporting documentation.
- 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 speech, language, and audiology-related medical records, claims, authorization requests, treatment plans, 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 and good-standing status, as applicable.
- Maintain knowledge of applicable medical policies, coverage requirements, professional 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.
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 $80,000 - $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.
