Medical Reviewer, Radiologist

Job not on LinkedIn

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $150k - $175k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 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 radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation • Evaluate imaging and radiology services based on applicable medical policies, coverage requirements, and clinical standards • Provide physician-level medical review and clinical expertise for complex radiology cases • Support medical necessity and appropriateness determinations for requested or billed radiology services • Document review findings, decisions, and supporting clinical rationale clearly and accurately • Refer or collaborate on cases requiring additional clinical expertise when appropriate • Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners • Maintain knowledge of applicable radiology standards, medical policies, coverage requirements, and regulatory guidelines • Meet established 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, document findings, and support timely determinations

🎯 Requirements

• Minimum of three (3) years of experience as a Radiologist in a private, academic, or government setting • Current, non-expired physician license from the State of California, 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 complex radiology-related medical records and supporting documentation • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status

🏖️ 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