Medical Reviewer (Podiatrist) - Remote CA

About the role

Gainwell 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%.

Pay

The pay range for this position is $110,000 – $130,000 per year; 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.