Medical Reviewer (Optometrist) - Remote CA

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.

Gainwell Technologies is seeking a Medical Reviewer (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs. Your role in our mission includes reviewing 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.

What we're looking for includes a 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.

What you should expect in this role includes a 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 optometry-related medical, clinical, claim, authorization, 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. Maintain knowledge of applicable medical policies, coverage requirements, clinical 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%.