SummaryAs a Physical Medicine & Rehabilitation (PM&R Physician) at Gainwell, you will provide senior-level clinical expertise and oversight for Physical Medicine & Rehabilitation (PM&R) programs. This role supports medical necessity determinations, provider engagement, clinical policy development, and quality improvement initiatives related to rehabilitation services, pain management, functional restoration, and durable medical equipment (DME). The Advisor Medical Expert serves as a trusted clinical advisor to clients, providers, and internal teams to promote high-quality, cost-effective healthcare outcomes.
Your role in our missionWhen joining Gainwell, you will:
- Serve as the physician subject matter expert for Physical Medicine & Rehabilitation, rehabilitation services, and functional restoration programs.
- Review complex authorization requests, appeals, and medical necessity determinations related to rehabilitation therapies, inpatient rehabilitation, DME, prosthetics, orthotics, and pain management services.
- Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate care decisions.
- Provide clinical guidance to utilization management, quality, case management, and operational teams.
- Interpret and apply Medicaid regulations, medical policies, and rehabilitation treatment guidelines to support program compliance.
- Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to rehabilitation services.
What we're looking for- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
- Active, unrestricted license to practice medicine in the State of California required.
- Board Certification in Physical Medicine & Rehabilitation (PM&R).
- Minimum of 5+ years of post-residency clinical experience in rehabilitation medicine, functional restoration, musculoskeletal conditions, disability management, or pain management.
- Strong knowledge of rehabilitation services, physical therapy, occupational therapy, speech therapy, DME, prosthetics, orthotics, and evidence-based clinical guidelines.
- Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities, with strong analytical, communication, and decision-making skills.
What you should expect in this role- Remote position supporting Medicaid rehabilitation and healthcare programs; candidates must be located within the United States while performing work.
- Full-time temporary assignment expected to last 9-12 months, with potential for extension based on business needs.
- Standard schedule: Monday-Friday, 8:00 AM-5:00 PM; flexibility required as needed.
- Collaborate with providers, clients, and multidisciplinary healthcare teams.
- Participate in peer reviews, case consultations, and clinical documentation reviews.
- Influence clinical policy, quality outcomes, and program effectiveness.
This is a pipeline requisition. Applications will be reviewed on an ongoing basis.
The pay range for this position is $152,000.00 - $217,200.00 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.
