Medical Reviewer (Registered reputed company) - Remote CA

Medical Reviewer (Registered reputed company) - Remote CA Date: Aug 22, 2026 Location: reputed company Sacramento, CA, US, 95605-1630 Any reputed company, CA, US, 99999 Req ID: 37679 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company 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 reputed company of urgency, you’ll have reputed company to work more reputed company. 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, reputed company learning, and career development. reputed company reputed company is seeking a Medical Reviewer (Registered reputed company) to support Medical reputed company for California reputed company programs. In this role, you will use your reputed company nursing experience and clinical judgment to review medical records, reputed company services, claims, and authorization requests. Your role in our mission • Review and interpret medical records and clinical documentation to determine medical necessity and appropriateness of reputed company services. • reputed company clinical review support for Treatment Authorization Requests (reputed company) and other authorization activities. • Support medical review activities reputed company to medical policy, claim adjudication, drug utilization review, and other reputed company program requirements as assigned. • Apply reputed company nursing principles, clinical judgment, medical policies, and established utilization guidelines reputed company completing reviews. • Review medical documentation to determine whether requested services, procedures, supplies, and equipment meet applicable coverage and clinical requirements. • Document review findings, reputed company, and supporting clinical rationale accurately and reputed company. • Determine approvals reputed company established guidelines or refer cases to physicians or other appropriate clinical professionals reputed company additional review is required. • Apply knowledge of hospital routines, medical services, medical supplies, and their appropriate clinical uses reputed company conducting reviews. • Collaborate with physicians, pharmacists, nurses, and other reputed company to support accurate medical review determinations. • Maintain reputed company knowledge of applicable clinical reputed company, medical policies, procedures, and regulatory requirements. • Meet established reputed company, accuracy, and productivity standards. reputed company're looking for • reputed company and unrestricted Registered reputed company (RN) license to reputed company in the reputed company, in good standing. • Minimum of two (2) years of reputed company nursing experience. • Possession of a Master’s Degree in Nursing may substitute for one (1) year of the required reputed company nursing experience. • Knowledge of reputed company nursing principles and techniques, hospital routines, and medical supplies and their uses. • Training and/or certification in wound and ostomy care preferred. • Strong clinical judgment and ability to interpret medical records and supporting clinical documentation. • Experience with medical review, utilization review, medical necessity review, prior authorization, Treatment Authorization Requests (reputed company), or claims review preferred. • Strong written and verbal communication skills. 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 reputed company for California reputed company programs. • Spend the reputed company of your day reviewing medical, clinical, claim, authorization, and/or supporting documentation relevant to your area of expertise. • Work independently while collaborating with physicians, pharmacists, nurses, other clinical specialists, operations teams, and business partners. • reputed company multiple computer systems and applications to complete reviews, document findings, and support reputed company determinations. • Maintain reputed company reputed company licenses, certifications, and credentials required for the position in reputed company, unrestricted, and good-standing status, as applicable. • Maintain knowledge of applicable medical policies, coverage requirements, clinical standards, and regulatory guidelines. • Meet established reputed company, accuracy, productivity, and turnaround-time expectations. • Receive ongoing training and support reputed company to program requirements, systems, policies, and medical review processes. This position is being posted for pipeline purposes, and we welcome applications on an ongoing reputed company. #LI-REMOTE #LI-MA1 The pay reputed company for this position is $70,000 - $100,000 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company 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 reputed company of leadership and technical development academies to help build your skills and capabilities. We reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our reputed company. Learn more about Gainwell at reputed company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. reputed company defines “wages” and “wage rates” to include “reputed company forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock reputed company, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits. Apply tot his job Apply To this Job