Medical Reviewer, Podiatrist

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $110k - $130k / 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 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 to review 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 • Collaborate with physicians, nurses, clinical specialists, operations teams, and business partners to resolve review questions • Maintain knowledge of podiatric standards, medical policies, coverage requirements, and regulatory guidelines • Meet quality, accuracy, productivity, and turnaround-time expectations • Work primarily from a home office supporting Medical Review Services for California healthcare programs • Navigate multiple computer systems and applications to complete reviews and document findings • Travel 0–10%

🎯 Requirements

• One (1) year of experience working in a variety of clinical settings is preferred • Doctorate or Diploma in Podiatric Medicine, or Diploma in Chiropody • Current California State license to practice Podiatry, in good standing • Strong clinical judgment • 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 • Ability to navigate multiple computer systems and applications • Ability to meet established quality, accuracy, productivity, and turnaround-time expectations

🏖️ Benefits

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