Medical Reviewer (Laboratory Specialist) - Remote CA (West Sacramento, CA, US, 9

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 (Laboratory Specialist) to provide laboratory subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation to help ensure laboratory services meet applicable coverage, medical necessity, and program requirements. Your role in our mission Review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation. Evaluate laboratory services based on applicable medical policies, coverage requirements, and program guidelines. Apply laboratory expertise when reviewing the appropriateness of requested or billed laboratory services. Support claim adjudication and medical review activities involving laboratory testing. Review supporting documentation for completeness and