Gainwell Technologies

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary As an Out-of-State Provider Specialist – Remote California at Gainwell, you will support California's Medi-Cal program by reviewing out-of-state healthcare claims, coordinating provider enrollment activities, and ensuring accurate processing in accordance with established program requirements. You'll work with healthcare providers, internal teams, and the California Department of Health Care Services (DHCS) to resolve issues, maintain accurate documentation, and support efficient claims and enrollment operations. Your role in our mission Review, research, and correct out-of-state (OOS) healthcare claims in accordance with Medi-Cal policies, procedures, and processing requirements. Process enrollment activities for out-of-state medical and outpatient providers, reviewing documentation for accuracy and completeness. Evaluate provider eligibility against established OOS criteria and refer providers who do not meet applicable requirements to DHCS for enrollment processing. Coordinate billing and enrollment materials, respond to provider inquiries, research discrepancies, and maintain accurate records and activity logs. Track daily and weekly activities, prepare required reports, and meet established productivity, quality, and contractual requirements. What we're looking for High school diploma or GED required; an associate or bachelor's degree in healthcare administration, business, or a related field is a plus. Experience in healthcare claims processing, provider enrollment, medical billing, Medicaid/Medi-Cal operations, or healthcare administrative support preferred. Knowledge of healthcare claims, provider enrollment procedures, medical billing terminology, or insurance reimbursement processes preferred. Strong analytical, problem-solving, organizational, and time-management skills with the ability to research discrepancies and maintain accurate records. Excellent communication and computer skills, including proficiency with Microsoft Office applications and the ability to work independently in a remote environment. What you should expect in this role 100% remote position. Applicants must reside in California. Full-time position supporting California's Medi-Cal program. Ability to work independently while collaborating with internal teams and healthcare providers. Reliable high-speed internet access and a private, professional workspace are required. This is a pipeline requisition to identify qualified candidates for anticipated future openings as business needs arise. The pay range for this position is $70,000 - $75,000 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 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. Originally posted on Himalayas

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 (Physician) to support Medical Review Services for California healthcare programs. This role provides physician-level clinical expertise supporting medical policy, claim adjudication, Treatment Authorization Requests (TARs), appeals, provider-related medical review activities, and other healthcare program requirements. Your role in our mission Perform physician-level medical reviews of claims, TARs, appeals, and other clinical documentation. Apply medical expertise, applicable policies, coverage requirements, and clinical standards when making or supporting review determinations. Provide technical and clinical expertise related to suspended claims, appeals, provider inquiries, and other medical review activities. Support medical policy interpretation and development as needed. Provide clinical expertise supporting drug utilization review when assigned. Document medical review findings and clinical rationale clearly and accurately. Collaborate with pharmacists, nurses, other clinicians, operations teams, and business partners. Maintain knowledge of applicable Medicaid, Medicare, California healthcare program, and regulatory requirements. Meet established quality, accuracy, productivity, and timeliness standards. What we're looking for Current, non-expired physician license from the State of California, in good standing. Must not be under suspension from Medicare, Medicaid, or the practice of medicine in California. Must not have been previously sanctioned for fraud or abuse. Three (3) years of experience as a medical consultant for a government or private-sector healthcare payer; or one (1) year of MMIS experience providing technical expertise and assistance for the entire suspended claims process, appeals process, and provider relations; or three (3) years of experience in drug utilization review. Strong oral and written communication skills. Strong clinical judgment and ability to interpret complex medical documentation. 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 medical, clinical, claim, authorization, and/or supporting documentation relevant to your area of expertise. Work independently while collaborating with physicians, pharmacists, 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, unrestricted, and good-standing status, as applicable. Maintain knowledge of applicable medical policies, coverage requirements, clinical 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%. This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $140,000 - $160,000 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 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

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 about Gainwell at our company website and visit our Careers site for all available job

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 (Durable Medical Equipment Specialist) to provide subject-matter expertise supporting Medical Review Services for California healthcare programs. In this role, you will review durable medical equipment (DME) claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation to help ensure equipment and services meet applicable medical necessity, coverage, billing, and program requirements. Your role in our mission Review DME-related claims, Treatment Authorization Requests (TARs), prescriptions, and supporting medical documentation. Evaluate requests for durable medical equipment based on applicable medical policies, coverage requirements, and program guidelines. Review documentation supporting the medical necessity and appropriate use of durable medical equipment. Apply knowledge of DME products, supplies, billing practices, and healthcare reimbursement when completing reviews. Support claim adjudication and authorization activities involving DME. Document review findings, decisions, and supporting rationale accurately and timely. Identify documentation, billing, or coverage issues requiring additional review or clarification. Collaborate with clinicians, providers, operations teams, and other Medical Review Services professionals. Maintain knowledge of applicable DME policies, coverage requirements, billing practices, and regulatory guidelines. Meet established quality, accuracy, productivity, and turnaround-time expectations. What we're looking for Minimum of three (3) years of professional experience working with Durable Medical Equipment (DME). Strong knowledge of DME products, equipment, supplies, and their uses. Management of a DME business and/or understanding of healthcare billing preferred. Ability to interpret medical documentation, prescriptions, claims, and supporting information. Strong analytical, documentation, 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 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 DME claims, authorization requests, prescriptions, medical documentation, billing information, and supporting records. Work independently while collaborating with physicians, nurses, other clinical specialists, providers, operations teams, and business partners. Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations. Maintain knowledge of applicable medical policies, DME coverage requirements, billing practices, 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 [[salaryMin]] - [[salaryMid]] 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 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

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 We are seeking a talented individual for anOutpatient Coding Auditor, Senior Associate who is responsible for performing coding reviews of medical records and/or other documentation to determine correct coding as defined by review methodologies specific to the contract for which review services are being provided. This involves accessing proprietary systems to audit medical records, accurately document findings and providing policy/regulatory support for determination. The candidate must have an extensive background in outpatient coding edits and has a high level of understanding in reimbursement guidelines specifically an understanding of the EAPG, ASC and APC payment systems. Your role in our mission Performs audits of medical record documentation to determine the accuracy of principal and secondary diagnosis (including MCC & CC) and procedure codes. Adheres to official coding guidelines, coding clinics and regulatory guidelines and mandates. Draws on advanced ICD-10 coding expertise to substantiate conclusions. Utilizes proprietary auditing systems with a high level of proficiency to document audit determinations and rationale. Consistently achieves productivity and quality performance standards established by management. Actively cross-trains to perform reviews of multiple claim types to provide a flexible workforce to meet client needs Assists management with training new Coding Auditors to include daily monitoring, mentoring, feedback and education. Maintains current knowledge of coding guidelines and successfully completes required CEUs to maintain coding certification. Responsible for attending training and scheduled meetings to enhance skills and working knowledge of clinical policies, procedures, rules, and regulations. What we're looking for One or more active professional credentials through AHIMA or AAPC: CPC, COC, CCS, RHIA, RHIT; required 2+ years experience of outpatient medical record coding and/or auditing; required Demonstrated proficiency in medical record auditing and ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, and CPT coding methodology. Demonstrated proficiency in computer skills and typing, i.e., Microsoft Windows, Outlook, Excel, Word, PowerPoint, Internet browsers and in virtual meeting tools i.e., Microsoft Teams, Zoom, etc. What you should expect in this role Remote (work from home) environment within the United States Benefits on first day of employment Clear path to advancement with training and leadership This posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis. The pay range for this position is $70,000.00 - $80,000.00 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 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. Originally pos

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 (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs. Your role in our mission Review optometry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation. Evaluate requested services against applicable medical policies, coverage requirements, and clinical standards. Apply professional optometric expertise when supporting medical necessity and coverage determinations. Document findings and clinical rationale accurately and timely. Refer cases requiring additional clinical review to appropriate medical professionals. Collaborate with clinical and operational partners to resolve review questions. Maintain knowledge of applicable policies and regulatory requirements. Meet established quality, accuracy, productivity, and turnaround-time standards. What we're looking for Minimum of one (1) year of experience working as an Optometrist. Doctor of Optometry degree from an accredited school of Optometry. Current, non-expired California license to practice as an Optometrist, in good standing. Must not be under suspension from Medicare, Medicaid, or practice in California. Must not have been previously sanctioned for fraud or abuse. Strong oral and written communication skills. Strong clinical judgment and ability to interpret medical records and supporting clinical documentation. What you should expect in this role 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 optometry-related medical, clinical, claim, authorization, 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, unrestricted, and good-standing status. Maintain knowledge of applicable medical policies, coverage requirements, clinical 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%. This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $100,000 - $120,000 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 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 a

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 (Podiatrist) to provide professional podiatric expertise supporting Medical Review Services for California healthcare programs. In this role, you will review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation to help ensure services meet applicable clinical, coverage, and program requirements. Your role in our mission Review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation. Evaluate requested podiatric services against applicable coverage requirements, medical policies, and clinical standards. Apply professional podiatric expertise and clinical judgment when reviewing medical necessity and appropriateness of services. Review treatment plans and supporting documentation for requested services. Document clinical findings, review decisions, and supporting 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 podiatric standards, medical policies, coverage requirements, and regulatory guidelines. Meet established quality, accuracy, productivity, and turnaround-time expectations. What we're looking for One (1) year of experience working in a variety of clinical settings, ranging from general podiatry services to working with a multi-professional team, is preferred. Doctorate or Diploma in Podiatric Medicine, or Diploma in Chiropody. Current California State license to practice Podiatry, in good standing. Strong clinical judgment and ability to interpret medical records, treatment plans, and supporting clinical documentation. Ability to work effectively with multidisciplinary healthcare teams. Strong written and verbal communication skills. 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 podiatry-related medical, clinical, claim, authorization, treatment plan, 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, unrestricted, and good-standing status, as applicable. Maintain knowledge of applicable medical policies, coverage requirements, podiatric 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%. This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $110,000 - $130,000 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 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

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 (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. This role supports pharmacy review, claim adjudication, drug rebate activities, drug utilization review, Treatment Authorization Requests (TARs), and other Medical Review Services functions. Your role in our mission Perform pharmacy and medication-related clinical reviews. Support pharmacy claim review and adjudication activities. Provide clinical expertise for drug utilization review and drug-related authorization requests. Support drug rebate and pharmacy program activities as assigned. Review pharmacy documentation for compliance with applicable policies and coverage requirements. Provide technical expertise and assistance related to pharmacy review. Document findings and recommendations accurately and timely. Collaborate with physicians, nurses, pharmacy teams, operations, and other healthcare professionals. Maintain knowledge of applicable pharmacy policies and regulatory requirements. What we're looking for Current, non-expired pharmacist license from the State of California, in good standing. Must not be under suspension from Medicare, Medicaid, or pharmacy practice in California. Must not have been previously sanctioned for fraud or abuse. Three (3) years of previous experience as a pharmacy consultant for a government or private-sector healthcare payer; or one (1) year of MMIS experience in a large state providing technical expertise and assistance for pharmacy review. Strong oral and written communication skills. Strong knowledge of pharmacy practices, medication review, and healthcare reimbursement processes. 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 pharmacy, clinical, claim, authorization, and supporting documentation. Work independently while collaborating with physicians, pharmacists, 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, unrestricted, and good-standing status. Maintain knowledge of applicable medical and pharmacy policies, coverage requirements, clinical 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%. This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis. The pay range for this position is $100,000 - $140,000 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 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. G