Job Description

Medical Reviewer (Prosthetic and Orthotic Devices Specialist) - Remote CA

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.

Gainwell Technologies is seeking a Medical Reviewer (Prosthetic and Orthotic Devices Specialist) to provide subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review prosthetic and orthotic device requests, claims, Treatment Authorization Requests (TARs), prescriptions, and supporting documentation to help ensure services and devices meet applicable coverage, medical necessity, and program requirements.

Your role in our mission includes:

• Reviewing claims, Treatment Authorization Requests (TARs), prescriptions, and supporting documentation involving prosthetic and orthotic devices.
• Evaluating prosthetic and orthotic requests based on applicable coverage requirements, medical policies, and professional standards.
• Assessing documentation supporting the medical need and appropriate use of prosthetic and orthotic devices.
• Providing subject-matter expertise related to prosthetic and orthotic equipment, services, and practices.
• Supporting claim adjudication and authorization activities involving prosthetic and orthotic services.
• Documenting review findings, decisions, and supporting rationale accurately and timely.
• Identifying documentation or coverage issues requiring additional review or clarification.
• Collaborating with clinicians, providers, operations teams, and other Medical Review Services specialists.
• Maintaining knowledge of applicable prosthetic and orthotic standards, coverage requirements, policies, and regulatory guidelines.
• Meeting established quality, accuracy, productivity, and turnaround-time expectations.

What we're looking for includes:

• Professional experience as a Prosthetic and Orthotic (P&O) practitioner consistent with program requirements.
• Certification in Prosthetics and Orthotics.
• Ownership or management of a Prosthetic and Orthotic business within the past five (5) years preferred.
• Strong knowledge of prosthetic and orthotic devices, services, and clinical applications.
• Ability to interpret medical documentation, prescriptions, and supporting device information.
• Strong analytical, written, and verbal communication skills.
• Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams.

What you should expect in this role includes:

• 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 prosthetic and orthotic claims, authorization requests, prescriptions, medical documentation, and supporting information.
• Work independently while collaborating with physicians, nurses, other clinical specialists, operations teams, providers, and business partners.
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
• Maintain all professional certifications and credentials required for the position in active and good-standing status, as applicable.
• Maintain knowledge of applicable medical policies, coverage requirements, professional 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.
• Travel requirement: 0-10%.

The pay range for this position is $70,000 - $90,000 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.

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."

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