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, productivity, and turnaround-time expectations. What we're looking for • Minimum of three (3) years of experience as a Speech, Language, or Audiology practitioner. • Current California professional credentials as applicable to the discipline. • Current Certificate of Clinical Competence in Speech-Language Pathology or Audiology granted by the American Speech-Language-Hearing Association, consistent with applicable program requirements. • Strong oral and written communication skills. • Strong clinical judgment and ability to interpret clinical records, treatment plans, and supporting documentation. • Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams. 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 Review Services for California healthcare programs. • Spend the majority of your day reviewing speech, language, and audiology-related medical records, claims, authorization requests, treatment plans, and supporting documentation. • Work independently while collaborating with physicians, nurses, 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, 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. This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $80,000 - $100,000 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. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more ...