Medical Reviewer (Radiologist) - Remote CA (West Sacramento, CA, US, 95605-1630)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

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

Your role in our mission

• 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.

What we're looking for

• 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.

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 radiology-related medical records, claims, authorization requests, imaging documentation, and supporting clinical information.

• Work independently while collaborating with physicians, nurses, 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, unrestricted, and good-standing status.

• Maintain knowledge of applicable medical policies, coverage requirements, radiology 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.

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

The pay range for this position is $150,000 - $175,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

Originally posted on Himalayas