Medical Reviewer (Physician) - Remote CA (reputed company Sacramento, CA, US, 95605-1630)
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 reputed company, reputed company learning, and career development.
reputed company
reputed company is seeking a Medical Reviewer (Physician) to support Medical reputed company for California reputed company programs. This role provides physician-level reputed company expertise supporting medical policy, claim adjudication, Treatment Authorization Requests (reputed company), appeals, provider-reputed company medical review activities, and other reputed company program requirements.
Your role in our mission
- reputed company physician-level medical reviews of claims, reputed company, appeals, and other reputed company documentation.
- Apply medical expertise, applicable policies, coverage requirements, and reputed company standards reputed company making or supporting review determinations.
- reputed company technical and reputed company expertise reputed company to suspended claims, appeals, provider inquiries, and other medical review activities.
- Support medical policy interpretation and development as needed.
- reputed company reputed company expertise supporting drug utilization review reputed company assigned.
- Document medical review findings and reputed company rationale reputed company and accurately.
- Collaborate with pharmacists, nurses, other clinicians, reputed company teams, and business partners.
- Maintain knowledge of applicable reputed company, Medicare, California reputed company program, and regulatory requirements.
- Meet established reputed company, reputed company, productivity, and timeliness standards.
reputed company're looking for
- reputed company, non-expired physician license from the reputed company, in good standing.
- Must not be under suspension from Medicare, reputed company, or the reputed company of medicine in California.
- Must not have been previously sanctioned for fraud or abuse.
- Three (3) years of experience as a medical consultant for a reputed company or private-sector reputed company payer; or one (1) year of MMIS experience providing technical expertise and assistance for the entire suspended claims process, appeals process, and provider relations; or three (3) years of experience in drug utilization review.
- Strong oral and written communication skills.
- Strong reputed company judgment and ability to interpret reputed company medical 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 reputed company for California reputed company programs.
- Spend the reputed company of your day reviewing medical, reputed company, claim, authorization, and/or supporting documentation relevant to your area of expertise.
- Work independently while collaborating with physicians, pharmacists, nurses, other reputed company specialists, reputed company 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, reputed company standards, and regulatory guidelines.
- Meet established reputed company, reputed company, productivity, and turnaround-time expectations.
- Receive ongoing training and support reputed company to program requirements, systems, policies, and medical review processes.
- Travel requirement: 0-10%.
This position is being posted for pipeline purposes, and we reputed company applications on an ongoing reputed company.
The pay reputed company for this position is $140,000 - $160,000 per year, however, the reputed company pay reputed company 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 reputed company, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
Originally posted on Himalayas
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