Medical Reviewer – Physical Therapist

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $85k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 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 • 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 • Work primarily from a home office while supporting Medical Review Services for California healthcare programs • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations

🎯 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 • Maintain all professional licenses, certifications, and credentials required for the position in active and good-standing status, as applicable • Monday through Friday work schedule • 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