Medical Reviewer, Radiologist
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Job Description
Radiologist reviewing California radiology claims, medical records, and authorization requests for Gainwell Technologies. Supporting medical necessity determinations for healthcare programs.
Responsibilities:
- 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
- Work primarily from a home office 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 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
- Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status
Benefits:
- Flexible 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
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