Medical Reviewer (Optometrist) - Remote CA

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

About the role

Gainwell Technologies is seeking a Medical Reviewer (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs.

• Review optometry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation.
• Evaluate requested services against applicable medical policies, coverage requirements, and clinical standards.
• Apply professional optometric expertise when supporting medical necessity and coverage determinations.
• Document findings and clinical rationale accurately and timely.
• Refer cases requiring additional clinical review to appropriate medical professionals.
• Collaborate with clinical and operational partners to resolve review questions.
• Maintain knowledge of applicable policies and regulatory requirements.
• Meet established quality, accuracy, productivity, and turnaround-time standards.

Requirements

• Minimum of one (1) year of experience working as an Optometrist.
• Doctor of Optometry degree from an accredited school of Optometry.
• Current, non-expired California license to practice as an Optometrist, in good standing.
• Must not be under suspension from Medicare, Medicaid, or practice in California.
• Must not have been previously sanctioned for fraud or abuse.
• Strong oral and written communication skills.
• Strong clinical judgment and ability to interpret medical records and supporting clinical documentation.

Schedule

• Full-time position.
• Remote work environment.
• Monday through Friday work schedule.
• Travel requirement: 0-10%.

Pay

The pay range for this position is $100,000 - $120,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Leadership and technical development academies to help build your skills and capabilities.