Remote Optometrist Medical Reviewer for Coverage & Records

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

Job summary

Gainwell Technologies is seeking a Medical Reviewer (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs.

The role is full-time with remote work, primarily home-based, Monday–Friday, focusing on reviewing optometry-related medical records, evaluating services against policies, and documenting findings with clinical rationale.

Qualifications

• OD degree from an accredited school of Optometry.
• Current, non-expired California license to practice as an Optometrist.
• Not under suspension from Medicare/Medicaid or CA practice.
• Not previously sanctioned for fraud or abuse.
• 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, coverage requirements, and clinical standards.
• Apply optometric expertise for 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.

Skills

Communication skills

Clinical judgment

Record interpretation

Education

Doctor of Optometry (OD)

California Optometrist License

Job description

Gainwell Technologies is seeking a Medical Reviewer (Optometrist) to provide professional optometric expertise supporting Medical Review Services for California healthcare programs.

The role is full-time with remote work, primarily home-based, Monday–Friday, focusing on reviewing optometry-related medical records, evaluating services against policies, and documenting findings with clinical rationale.