Medical Reviewer, Podiatrist
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Job Description
Podiatrist reviewing medical records, claims, and treatment authorizations for Gainwell Technologies’ California healthcare programs. Applying clinical judgment to medical necessity and coverage decisions.
Responsibilities:
- Review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation
- Evaluate requested podiatric services against applicable coverage requirements, medical policies, and clinical standards
- Apply professional podiatric expertise and clinical judgment to review medical necessity and appropriateness of services
- Review treatment plans and supporting documentation for requested services
- Document clinical findings, review decisions, and supporting rationale accurately and timely
- Refer cases requiring additional clinical review to appropriate medical professionals
- Collaborate with physicians, nurses, clinical specialists, operations teams, and business partners to resolve review questions
- Maintain knowledge of podiatric standards, medical policies, coverage requirements, and regulatory guidelines
- Meet 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 and document findings
- Travel 0–10%
Requirements:
- One (1) year of experience working in a variety of clinical settings is preferred
- Doctorate or Diploma in Podiatric Medicine, or Diploma in Chiropody
- Current California State license to practice Podiatry, in good standing
- Strong clinical judgment
- Ability to interpret medical records, treatment plans, and supporting clinical documentation
- Ability to work effectively with multidisciplinary healthcare teams
- Strong written and verbal communication skills
- Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status
- Ability to navigate multiple computer systems and applications
- Ability to meet established quality, accuracy, productivity, and turnaround-time expectations
Benefits:
- Flexible work 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
- Remote work environment
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