Medical Reviewer (Physical Therapist) - Remote CA (West Sacramento, CA, US, 9560

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 (Physical Therapist) to provide clinical expertise supporting Medical Review Services for California healthcare programs. In this role, you will review therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation to help ensure services meet applicable clinical, coverage, and program requirements. Your role in our mission Review physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation. Evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements. Apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations. Review treatment plans and supporting documentation for requested services. Docume