Remote Medical Reviewer - Prosthetics & Orthotics Expert

Gainwell Technologies; West Sacramento (CA); Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

401(k) employer match

Comprehensive health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies is seeking a Medical Reviewer (Prosthetic and Orthotic Devices Specialist) to support California healthcare programs. You will review prosthetic and orthotic device requests, TARs, prescriptions, and supporting documentation to ensure services meet coverage, medical necessity, and program requirements.

The role emphasizes collaboration with clinicians, providers, and cross-functional teams, while maintaining knowledge of standards and regulations. Remote work is supported.

Qualifications

• P&O practitioner with program requirements.
• Certification in Prosthetics and Orthotics.
• Ownership or management of a P&O business preferred within past 5 years.
• Ability to interpret medical documentation, prescriptions, and device information.

Responsibilities

• Review prosthetic and orthotic device claims, TARs, prescriptions, and documentation.
• Assess coverage requirements, medical policies, and professional standards.
• Evaluate medical need and appropriate use of devices.
• Provide subject-matter expertise on prosthetic and orthotic equipment and practices.
• Support claim adjudication and authorization activities.
• Document findings and rationale accurately and timely.
• Collaborate with clinicians, providers, and cross-functional teams.
• Maintain knowledge of policies, standards, and regulatory guidelines.

Skills

P&O practitioner experience

Communication skills

Independent worker

Education

Certification in Prosthetics and Orthotics

Job description

Gainwell Technologies is seeking a Medical Reviewer (Prosthetic and Orthotic Devices Specialist) to support California healthcare programs. You will review prosthetic and orthotic device requests, TARs, prescriptions, and supporting documentation to ensure services meet coverage, medical necessity, and program requirements.

The role emphasizes collaboration with clinicians, providers, and cross-functional teams, while maintaining knowledge of standards and regulations. Remote work is supported.