Medical Reviewer – Physical Therapist
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Job Description
Medical Reviewer evaluating physical therapy records, claims, and authorizations for Gainwell Technologies’ California healthcare programs. Supporting clinical necessity and coverage determinations remotely.
Responsibilities:
- 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
- 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
- Work primarily from a home office while 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 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
- Maintain all professional licenses, certifications, and credentials required for the position in active and good-standing status, as applicable
- Monday through Friday work schedule
- Travel requirement: 0-10%
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
- Remote work environment
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