Medical Reviewer (Radiologist) - Remote CA

Summary

Gainwell Technologies is seeking a Medical Reviewer (Radiologist) to provide physician-level radiology expertise supporting Medical Review Services for California healthcare programs. In this role, you will review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation to help ensure services meet applicable medical necessity, coverage, and program requirements.

Your role in our mission

• Review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation.
• Evaluate imaging and radiology services based on applicable medical policies, coverage requirements, and clinical standards.
• Provide physician-level medical review and clinical expertise for complex radiology cases.
• Support medical necessity and appropriateness determinations for requested or billed radiology services.
• Document review findings, decisions, and supporting clinical rationale clearly and accurately.
• Refer or collaborate on cases requiring additional clinical expertise when appropriate.
• Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners.
• Maintain knowledge of applicable radiology standards, medical policies, coverage requirements, and regulatory guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.

What we're looking for

• Minimum of three (3) years of experience as a Radiologist in a private, academic, or government setting.
• Current, non-expired physician license from the State of California, in good standing.
• Must not be under suspension from Medicare, Medicaid, or practice in California.
• Must not have been previously sanctioned for fraud or abuse.
• Strong oral and written communication skills.
• Strong clinical judgment and ability to interpret complex radiology-related medical records and supporting documentation.

What you should expect in this role

• Full-time position.
• Remote work environment.
• Monday through Friday work schedule.
• Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
• Spend the majority of your day reviewing radiology-related medical records, claims, authorization requests, imaging documentation, and supporting clinical information.
• Work independently while collaborating with physicians, nurses, other clinical specialists, operations teams, and business partners.
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
• Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status.
• Maintain knowledge of applicable medical policies, coverage requirements, radiology standards, and regulatory guidelines.
• Meet established quality, accuracy, productivity, and turnaround-time expectations.
• Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.

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