Medical Reviewer (Physical Therapist) - Remote CA (West Sacramento, CA, US, 9560

Summary

Gainwell Technologies is seeking a Medical Reviewer (Physical Therapist) to provide clinical expertise supporting Medical Review Services for California healthcare programs. In this role, you will review therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation to help ensure services meet applicable clinical, coverage, and program requirements.

Your role in our mission

• 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.
• Review treatment plans and supporting documentation for requested services.
• 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.

What we're looking for

• 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.

What you should expect in this role

• Full-time position.
• Remote work environment.
• Monday through Friday work schedule.
• Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
• Spend the majority of your day reviewing physical therapy-related medical, clinical, claim, authorization, treatment plan, and supporting documentation.
• Work independently while collaborating with physicians, nurses, therapists, other clinical specialists, operations teams, and business partners.
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
• Maintain all professional licenses, certifications, and credentials required for the position in active and good-standing status, as applicable.
• Maintain knowledge of applicable medical policies, coverage requirements, physical therapy standards, and regulatory guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.
• Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.
• Travel requirement: 0-10%.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.