Principal Medical Expert

Date: Oct 1, 2026

Location:

Any city, CA, US, 99999

Req ID: 38395

Work Mode: Default

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

The Principal Medical Expert provides advanced clinical medicine expertise across a broad category of medical specialties, to include pediatric and adult medicine, occupational health, surgery, psychiatric, and basic obstetrics and gynecology. Board certified or board eligible physician with ten or more years of direct patient care experience across a broad spectrum of pediatric and adult medical specialties to perform online review of medical documentation requiring the expertise of a licensed physician with strong clinical experience.

The Principal Medical Expert provides advanced clinical medical expertise across a broad range of medical specialties to adjudicate complex medical claims, referrals, and appeals requiring the expertise of a physician with a strong background in direct clinical patient care.

Your role in our mission

The Principal Medical Expert is responsible for responding to referrals from DHCS within 4 hours of notification.
Reviewing policy and attending meetings with DHCS
Assist DHCS with development, and implementation of medical policy upon request.
Respond to requests for review of records for medical justification from the Conlan Unit.
Report suspected billing fraud.
Review and adjudicate complex medical claims.
Review and respond to referrals from internal departments requiring the knowledge of a license physician.
Expect to cross train to help provide coverage for other consultants when required.
Ensure timely claims adjudication and referral completion.
Provide medical expertise across multiple divisions, ensuring accurate diagnosis, treatment protocols, and adherence to occupational health standards.
Partner with senior leadership and cross-functional teams to assess program effectiveness and recommend improvements or alternative approaches.
Contribute to division-wide, multidisciplinary initiatives requiring medical expertise; influence strategy and execution.
Lead, develop, and manage team performance through coaching, training, and performance oversight.

What we're looking for

Current, active, unrestricted California medical license
Board certification preferred
Medical degree (Doctorate of Medicine or Doctorate of Osteopathy)
10+ years of progressive medical experience
Experience with occupational health practices and procedures
Experience with regulatory compliance, including OSHA and related guidelines
Experience with policy development and implementation
Experience with budget management and financial oversight
Strong functional computer skills, including proficiency with Microsoft Outlook, Windows, and Excel
Strong communication and presentation skills
Demonstrated analytical and problem-solving capabilities
Strong organizational skills with the ability to manage multiple priorities
Proven leadership skills, including mentoring and developing others

What you should expect in this role

Hybrid work schedule.
Must reside within 35 miles of the California State Capitol in Sacramento, CA
Willingness to travel as needed

Applications will be accepted through October 15.

The pay range for this position is $121,700.00 - $173,800.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.