Medical Reviewer – Speech and Audiology Specialist
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Job Description
Medical Reviewer applying speech, language, and audiology expertise to California healthcare claims and authorizations. Supporting medical necessity decisions for Gainwell Technologies’ healthcare programs.
Responsibilities:
- Review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation
- Evaluate requested services based on applicable medical policies, coverage requirements, and professional standards
- Apply speech-language pathology or audiology expertise to support medical necessity and appropriateness determinations
- Review treatment plans and supporting documentation for requested or billed services
- Document review findings, decisions, and supporting clinical rationale accurately and timely
- Refer cases requiring additional clinical review to appropriate medical professionals when needed
- Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions
- Maintain knowledge of applicable professional standards, medical policies, coverage requirements, and regulatory guidelines
- Meet established quality, accuracy, productivity, and turnaround-time expectations
- Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations
- Support Medical Review Services for California healthcare programs
Requirements:
- Minimum of three (3) years of experience as a Speech, Language, or Audiology practitioner
- Current California professional credentials as applicable to the discipline
- Current Certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech-Language-Hearing Association, consistent with applicable program requirements
- Strong oral and written communication skills
- Strong clinical judgment and ability to interpret clinical records, treatment plans, and supporting documentation
- 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
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 related to program requirements, systems, policies, and medical review processes
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