Medical Reviewer (Podiatrist) - Remote CA

Medical Reviewer (Podiatrist) - 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 (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%.

The pay range for this position is $110,000 - $130,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.