Medical Reviewer – Prosthetic and Orthotic Devices Specialist

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $70k - $90k / 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 claims, Treatment Authorization Requests (TARs), prescriptions, and supporting documentation involving prosthetic and orthotic devices • Evaluate prosthetic and orthotic requests based on applicable coverage requirements, medical policies, and professional standards • Assess documentation supporting the medical need and appropriate use of prosthetic and orthotic devices • Provide subject-matter expertise related to prosthetic and orthotic equipment, services, and practices • Support claim adjudication and authorization activities involving prosthetic and orthotic services • Document review findings, decisions, and supporting rationale accurately and timely • Identify documentation or coverage issues requiring additional review or clarification • Collaborate with clinicians, providers, operations teams, and other Medical Review Services specialists • Maintain knowledge of applicable prosthetic and orthotic standards, coverage requirements, policies, and regulatory guidelines • Meet established quality, accuracy, productivity, and turnaround-time expectations • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations

🎯 Requirements

• Professional experience as a Prosthetic and Orthotic (P&O) practitioner consistent with program requirements • Certification in Prosthetics and Orthotics • Ownership or management of a Prosthetic and Orthotic business within the past five (5) years preferred • Strong knowledge of prosthetic and orthotic devices, services, and clinical applications • Ability to interpret medical documentation, prescriptions, and supporting device information • Strong analytical, written, and verbal communication skills • Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams • Maintain all professional certifications and credentials required for the position in active and good-standing status, as applicable

🏖️ Benefits

• Flexible 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