Medical Reviewer (Radiologist) - Remote CA (West Sacramento, CA, US, 95605-1630)

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. 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