Remote Internal Medicine Physician, Medicaid Expert

Gainwell Technologies; California (MO); Hybrid; USD 152,000 - 217,000; Full time

Benefits offered by this job

Generous, flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development

Job summary

Gainwell Technologies seeks an Internal Medical Physician to provide medical oversight across Medicaid services, reviewing medical necessity and guiding utilization decisions in inpatient, outpatient, and post-acute settings.

The role requires MD/DO with active U.S. license, California license, and 5+ years in internal/general medicine, with remote work flexibility and ongoing professional development opportunities. The assignment is full-time and temporary, within the U.S.

Qualifications

• MD or DO with active, unrestricted U.S. medical license.
• Active, unrestricted license to practice medicine in California.
• Board Certification in Internal Medicine, Family Medicine, or a related primary care specialty.
• Minimum of five years of post-residency clinical practice in Internal Medicine, General Medicine, hospital medicine, or related settings.
• Strong knowledge of evidence-based medicine, chronic disease management, and care delivery across diverse patient populations.
• Experience with Medicaid programs, utilization management, prior authorization, appeals, quality review, or medical necessity determinations preferred.
• Knowledge of nationally recognized clinical guidelines and healthcare quality standards.
• Excellent analytical, communication, and decision-making skills, with the ability to work independently in a remote environment.
• Experience conducting physician peer-to-peer reviews and collaborating with multidisciplinary clinical teams preferred.

Responsibilities

• Serve as the physician subject matter expert for General Medicine and Internal Medicine services within Medicaid and government healthcare programs.
• Review complex authorization requests, appeals, and medical necessity determinations across inpatient, outpatient, post-acute, and specialty care settings.
• Conduct peer-to-peer consultations with treating providers and apply evidence-based clinical criteria to support appropriate care decisions.
• Provide clinical guidance to utilization management, care management, quality improvement, and operational teams.
• Interpret and apply Medicaid regulations, medical policies, and nationally recognized clinical guidelines to support program compliance.
• Collaborate with clients, providers, and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to appropriate care.
• Support development and maintenance of clinical policies, review guidelines, and utilization management strategies.
• Participate in complex case reviews and multidisciplinary discussions involving high-risk or medically complex populations.

Skills

Analytical skills

Communication skills

Decision-making

Independent work

Remote work experience

Education

MD or DO

Medical license (US)

Board Certification in Internal or Family Medicine

Job description

Gainwell Technologies seeks an Internal Medical Physician to provide medical oversight across Medicaid services, reviewing medical necessity and guiding utilization decisions in inpatient, outpatient, and post-acute settings.

The role requires MD/DO with active U.S. license, California license, and 5+ years in internal/general medicine, with remote work flexibility and ongoing professional development opportunities. The assignment is full-time and temporary, within the U.S.