Medical Reviewer; Physical Therapist; Remote CA

Medical Reviewer (Physical Therapist) - Remote CA

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

Your role in our mission includes reviewing physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation. You will evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements. You will apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations. You will review treatment plans and supporting documentation for requested services.

You will document review findings and clinical rationale accurately and timely. You will refer cases requiring additional clinical review to appropriate medical professionals when needed. You will collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to resolve review questions. You will maintain knowledge of applicable physical therapy standards, medical policies, coverage requirements, and regulatory guidelines. You will meet established quality, accuracy, productivity, and turnaround-time expectations.

What we're looking for includes a minimum of three (3) years of experience as a Physical Therapist. Graduation from an accredited school of Physical Therapy. California license to practice Physical Therapy, or eligibility for California licensure. Current professional certification in good standing. Strong clinical judgment and ability to interpret medical records, treatment plans, and therapy-related documentation. Strong 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 a 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 physical therapy-related medical, clinical, claim, authorization, treatment plan, and supporting documentation. Work independently while collaborating with physicians, nurses, therapists, 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 and good-standing status, as applicable. Maintain knowledge of applicable medical policies, coverage requirements, physical therapy 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%.