Medical Reviewer (Optometrist) - Remote CA (West Sacramento, CA, US, 95605-1630)

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 (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs. Your role in our mission Review optometry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation. Evaluate requested services against applicable medical policies, coverage requirements, and clinical standards. Apply professional optometric expertise when supporting medical necessity and coverage determinations. Document findings and clinical rationale accurately and timely. Refer cases requiring additional clinical review to appropriate medical professionals. Collaborate with clinical and operational partners to resolve review questions. Maintain knowledge of applicable policies and regulatory requirements. Meet established quality, accuracy, productivity, and turnaround-time standard