Medical Reviewer (Speech and Audiology Specialist) - Remote CA (West Sacramento,

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 (Speech and Audiology Specialist) to provide subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation to help ensure services meet applicable medical necessity, coverage, and program requirements. Your role in our mission Review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation. Evaluate requested services based on applicable medical policies, coverage requirements, and professional standards. Apply speech-language pathology or audiology expertise to support medical necessity and appropriateness determinations. Review treatment plans and supporting documentation for requested or billed services. Document review findings, decisions, and supporting clinical rationale accurately and timely. Refer cases requiring additional clinical review to appropriate medical professionals when needed. Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions. Maintain knowledge of applicable professional standards, medical policies, coverage requirements, and regulatory guidelines. Meet established quality, accuracy, prod