Medical Reviewer (Physical Therapist) - Remote CA

Gainwell Technologies LLC•West Sacramento, CA

1d•$85,000 - $100,000•Remote

About The Position

Gainwell Technologies is seeking a Medical Reviewer (Physical Therapist) to provide clinical expertise supporting Medical Review Services for California healthcare programs. In this role, you will review therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation to help ensure services meet applicable clinical, coverage, and program requirements. You will spend the majority of your day reviewing physical therapy-related medical, clinical, claim, authorization, treatment plan, and supporting documentation. You will also navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations. The role involves ongoing training and support related to program requirements, systems, policies, and medical review processes.

Requirements

Minimum of three (3) years of experience as a Physical Therapist.
Graduation from an accredited school of Physical Therapy.
California license to practice Physical Therapy, or eligibility for California licensure.
Current professional certification in good standing.
Strong clinical judgment and ability to interpret medical records, treatment plans, and therapy-related documentation.
Strong written and verbal communication skills.
Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.

Responsibilities

Review physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation.
Evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements.
Apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations.
Review treatment plans and supporting documentation for requested services.
Document review findings and clinical rationale accurately and timely.
Refer cases requiring additional clinical review to appropriate medical professionals when needed.
Collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to resolve review questions.
Maintain knowledge of applicable physical therapy 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.