Medical Reviewer, Optometrist

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $100k - $120k / year

⏰ Full Time

🟢 Junior

🔍🏥 Medical Reviewer

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Review 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 to support 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 • Work primarily from a home office supporting Medical Review Services for California healthcare programs • Work independently while collaborating with physicians, nurses, clinical specialists, operations teams, and business partners • Navigate multiple computer systems and applications to complete reviews and document findings

🎯 Requirements

• 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 • Ability to maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status • Travel requirement: 0-10%

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • Ongoing training and support • Remote work environment