Medical Reviewer (Radiologist) - Remote CA

About the role

Gainwell Technologies is seeking a Medical Reviewer (Radiologist) to provide physician-level radiology expertise supporting Medical Review Services for California healthcare programs. In this role, you will review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation to help ensure services meet applicable medical necessity, coverage, and program requirements.

Responsibilities

• Review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation.
• Evaluate imaging and radiology services based on applicable medical policies, coverage requirements, and clinical standards.
• Provide physician-level medical review and clinical expertise for complex radiology cases.
• Support medical necessity and appropriateness determinations for requested or billed radiology services.
• Document review findings, decisions, and supporting clinical rationale clearly and accurately.
• Refer or collaborate on cases requiring additional clinical expertise when appropriate.
• Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners.
• Maintain knowledge of applicable radiology standards, medical policies, coverage requirements, and regulatory guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.

Requirements

• Minimum of three (3) years of experience as a Radiologist in a private, academic, or government setting.
• Current, non-expired physician license from the State of California, 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 complex radiology-related medical records and supporting documentation.

Schedule

• Full-time position.
• Remote work environment.
• Monday through Friday work schedule.

Pay

The pay range for this position is $150,000 - $175,000 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 to help build your skills and capabilities.