Medical Reviewer (Physician) - 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 (Physician) to support Medical Review Services for California healthcare programs. This role provides physician-level clinical expertise supporting medical policy, claim adjudication, Treatment Authorization Requests (TARs), appeals, provider-related medical review activities, and other healthcare program requirements. Your role in our mission Perform physician-level medical reviews of claims, TARs, appeals, and other clinical documentation. Apply medical expertise, applicable policies, coverage requirements, and clinical standards when making or supporting review determinations. Provide technical and clinical expertise related to suspended claims, appeals, provider inquiries, and other medical review activities. Support medical policy interpretation and development as needed. Provide clinical expertise supporting drug utilization review when assigned. Document medica