Physical Medicine & Rehabilitation (PM&R Physician)- California

Gainwell Technologies LLC•Any city, OH

2d•$152,000 - $217,200•Remote

About The Position

As a Physical Medicine & Rehabilitation (PM&R Physician) at Gainwell, you will provide senior-level clinical expertise and oversight for Physical Medicine & Rehabilitation (PM&R) programs. This role supports medical necessity determinations, provider engagement, clinical policy development, and quality improvement initiatives related to rehabilitation services, pain management, functional restoration, and durable medical equipment (DME). The Advisor Medical Expert serves as a trusted clinical advisor to clients, providers, and internal teams to promote high-quality, cost-effective healthcare outcomes.

Requirements

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
Active, unrestricted license to practice medicine in the State of California required.
Board Certification in Physical Medicine & Rehabilitation (PM&R).
Minimum of 5+ years of post-residency clinical experience in rehabilitation medicine, functional restoration, musculoskeletal conditions, disability management, or pain management.
Strong knowledge of rehabilitation services, physical therapy, occupational therapy, speech therapy, DME, prosthetics, orthotics, and evidence-based clinical guidelines.
Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities, with strong analytical, communication, and decision-making skills.

Responsibilities

Serve as the physician subject matter expert for Physical Medicine & Rehabilitation, rehabilitation services, and functional restoration programs.
Review complex authorization requests, appeals, and medical necessity determinations related to rehabilitation therapies, inpatient rehabilitation, DME, prosthetics, orthotics, and pain management services.
Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate care decisions.
Provide clinical guidance to utilization management, quality, case management, and operational teams.
Interpret and apply Medicaid regulations, medical policies, and rehabilitation treatment guidelines to support program compliance.
Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to rehabilitation services.
Collaborate with providers, clients, and multidisciplinary healthcare teams.
Participate in peer reviews, case consultations, and clinical documentation reviews.
Influence clinical policy, quality outcomes, and program effectiveness.