Prior Authorization Physician (Part-time)- Contractor

Gainwell Technologies; Northern (KY); Hybrid; USD 234,000 - 280,000; Part time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies seeks a Prior Authorization Physician to provide medical expertise and clinical oversight in utilization management within a Medicaid-focused environment. This remote, part-time contractor role reviews medical necessity requests and ensures decisions align with program guidelines.

You will apply clinical judgment across complex cases, participate in peer discussions with providers, and support access to cost-effective care.

Qualifications

• MD/DO with Psychiatry specialty required.
• Unrestricted US medical license required.
• Physically located in the United States.
• Experience in Prior Authorization and/or Utilization Review, preferably in Medicaid or managed care.

Responsibilities

• Provide medical expertise and clinical oversight for utilization management decisions.
• Review medical necessity requests and documentation against program guidelines.
• Engage in peer-to-peer discussions with providers to inform clinical decisions.
• Review complex cases and assist with appeals as needed.
• Collaborate with cross-functional teams to improve program effectiveness and access to care.

Skills

Clinical oversight

Utilization management

Medical leadership

Regulatory interpretation

Peer-to-peer discussions

Analytical skills

Time management

Independent work

Education

MD/DO with Psychiatry

Job description

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Date: Sep 10, 2026

Location: Any city, AZ, 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.

Summary

As a Prior Authorization Physician, you will provide medical expertise and clinical oversight in support of utilization management and prior authorization activities within a Medicaid-focused healthcare environment. This remote, part-time contractor role is responsible for reviewing medical necessity requests, evaluating clinical documentation, and ensuring care decisions are evidence-based, appropriate, and aligned with established program guidelines.

Your role in our mission

In this role, you will help improve healthcare quality and access by applying clinical expertise to utilization management decisions and supporting medically necessary, cost-effective care for members. Key responsibilities include:

• Serving as a clinical subject matter expert for staff, leadership, clients, and providers.


• Conducting medical necessity reviews for requested services, medications, and procedures using established clinical criteria.


• Participating in peer-to-peer discussions with providers to support informed clinical decisions.


• Reviewing complex clinical cases, documentation, and healthcare-related issues.


• Assisting with utilization management activities and medically complex claim reviews.


• Interpreting clinical, regulatory, and procedural guidelines to support accurate decision-making.


• Collaborating with cross-functional teams to improve program effectiveness, quality outcomes, and access to care.


• Participate in the appeals process where indicated.

What we're looking for

• Medical degree (MD or DO) with a specialty in Psychiatry.


• Unrestricted license to practice medicine in the United States.


• Physically located in the United States.


• Prior Authorization and/or Utilization Review experience, preferably within Medicaid or managed care environments.


• Experience providing clinical oversight and medical leadership.


• Knowledge of Medicaid and healthcare utilization management.


• Strong clinical judgment and decision-making skills.


• Excellent verbal and written communication skills.


• Ability to interpret complex clinical, regulatory, and procedural documents.


• Strong analytical, organizational, and time management skills.


• Proficiency with standard computer applications.


• Ability to work independently and collaborate effectively across teams.

What you should expect in this role

• Remote, part-time contractor position (25-30 hours per week).


• Opportunity to influence quality outcomes and healthcare program effectiveness.


• Collaborative environment with frequent interaction across multidisciplinary teams and healthcare providers.


• Independent, clinically focused work requiring sound medical judgment and decision-making.


• Candidates must be located within the United States while performing work.

Pipeline Requisition: Will receive applications on a daily basis.

The pay range for this position is $234,000.00 - $280,000.00 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.