Medical Reviewer (Laboratory Specialist) - Remote CA

Gainwell Technologies LLC • Full-time • Remote (Sacramento, California, United States) • $50k / year • 2d ago

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. 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. Gainwell Technologies is seeking a

Medical Reviewer (Laboratory Specialist) to provide laboratory subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation to help ensure laboratory services meet applicable coverage, medical necessity, and program requirements. Review laboratory-related claims, Treatment Authorization Requests (TARs), orders, and supporting documentation. Evaluate laboratory services based on applicable medical policies, coverage requirements, and program guidelines. Support claim adjudication and medical review activities involving laboratory testing. Document review findings, decisions, and supporting rationale accurately and timely. Identify documentation, billing, or coverage issues requiring additional review or clarification. Collaborate with clinical, operational, provider-facing, and other Medical Review Services teams to resolve laboratory review questions. Maintain knowledge of applicable laboratory practices, medical policies, coverage requirements, and healthcare program guidelines. Meet established quality, accuracy, productivity, and turnaround-time expectations. High school diploma or equivalent. Completion of a Medical Laboratory Technician program from an accredited medical laboratory technician school. Knowledge of laboratory procedures, terminology, testing, and documentation. Ability to interpret laboratory-related records, orders, claims, and supporting documentation. 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 laboratory-related claims, authorization requests, orders, medical documentation, and supporting records. 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 knowledge of applicable medical policies, laboratory practices, coverage requirements, 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: This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis #LI-REMOTE #The pay range for this position is $50,000 - $60,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. 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. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. 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.