Medical Reviewer (Optometrist) - Remote CA

Gainwell Technologies; West Sacramento (CA); Remote; USD 100,000 - 120,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Medical Reviewer (Optometrist) to provide professional optometric expertise for California healthcare programs. This full-time, remote California role involves reviewing records, applying clinical judgment, and supporting determinations from home.

Applicants must hold a Doctor of Optometry, an active CA license, and have at least one year of experience. The position offers a Monday–Friday schedule with comprehensive benefits and career development opportunities.

Qualifications

• Minimum of 1 year of experience as an optometrist.
• Strong oral and written communication skills.
• Strong clinical judgment and ability to interpret medical records.

Responsibilities

• Review optometry-related medical records, claims, TARs and supporting documentation.
• Evaluate services against medical policies and standards.
• Document findings and rationale accurately and timely.
• Collaborate with clinical and operational partners to resolve questions.

Skills

Optometrist experience

Communication skills

Clinical judgment

Education

Doctor of Optometry

Job description

Date: Aug 22, 2026

Location: West Sacramento, CA, US, 95605-1630 Any city, CA, US, 99999

Work Mode: Virtual (Exception only)

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.

Medical Reviewer (Optometrist) - Remote CA

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

• 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.

#LI-REMOTE

#LI-MA1

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 and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.