Medical Reviewer (Speech and Audiology Specialist) - 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 (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.

Responsibilities

• 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.
• Maintain all professional licenses, certifications, and credentials required for the position in active and good-standing status, as applicable.
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
• Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.

Requirements

• 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.

Schedule

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

Pay

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.

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.