Medical Reviewer – Speech and Audiology Specialist

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $80k - $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 speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation • Evaluate requested services based on applicable medical policies, coverage requirements, and professional standards • Apply speech-language pathology or audiology expertise to support medical necessity and appropriateness determinations • Review treatment plans and supporting documentation for requested or billed services • Document review findings, decisions, and supporting clinical rationale accurately and timely • Refer cases requiring additional clinical review to appropriate medical professionals when needed • Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions • Maintain knowledge of applicable professional standards, medical policies, coverage requirements, 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 • Support Medical Review Services for California healthcare programs

🎯 Requirements

• Minimum of three (3) years of experience as a Speech, Language, or Audiology practitioner • Current California professional credentials as applicable to the discipline • Current Certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech-Language-Hearing Association, consistent with applicable program requirements • Strong oral and written communication skills • Strong clinical judgment and ability to interpret clinical records, treatment plans, and supporting documentation • 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

🏖️ 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 related to program requirements, systems, policies, and medical review processes