Medical Reviewer (Podiatrist) - Remote CA
About The Position
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 involves reviewing podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation. You will evaluate requested podiatric services against applicable coverage requirements, medical policies, and clinical standards. You will apply professional podiatric expertise and clinical judgment when reviewing medical necessity and appropriateness of services. You will review treatment plans and supporting documentation for requested services. You will document clinical findings, review decisions, and supporting rationale accurately and timely. You will refer cases requiring additional clinical review to appropriate medical professionals when needed. You will collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions. You will maintain knowledge of applicable podiatric standards, medical policies, coverage requirements, and regulatory guidelines. You will meet established quality, accuracy, productivity, and turnaround-time expectations.
Requirements
- 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.
- 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.
Nice To Haves
- 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.
Responsibilities
- 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.
Benefits
- flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
