Medical Reviewer, Optometrist

Gainwell Technologies

Medical Reviewer applying optometric expertise to California healthcare claims, records, and authorizations. Supporting medical necessity determinations for Gainwell Technologies’ healthcare programs.

Posted 8/22/2026full-timeRemote • California • 🇺🇸 United StatesJunior💰 $100,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in optometry with a focus on reviewing medical records, claims, and Treatment Authorization Requests (TARs) while ensuring compliance with clinical standards and regulatory requirements. Strong ability to communicate findings and collaborate effectively with healthcare professionals.

Highest-signal resume keywords

Doctor Of Optometry DegreeCalifornia Optometrist LicenseClinical JudgmentMedical Record InterpretationCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

OptometryMedical Record ReviewClaims EvaluationClinical DocumentationCoverage DeterminationRegulatory ComplianceQuality StandardsProductivity StandardsTurnaround Time ManagementClinical Rationale Documentation

Soft Skills

CollaborationIndependent WorkOral CommunicationWritten Communication

Tools & Technologies

Computer SystemsApplications for Medical Review

Certifications & Qualifications

California Optometrist License

Industry Keywords

Medical Review ServicesHealthcare ProgramsTARsMedicareMedicaid

About the role

Key responsibilities & impact

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 to support 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
Work primarily from a home office supporting Medical Review Services for California healthcare programs
Work independently while collaborating with physicians, nurses, clinical specialists, operations teams, and business partners
Navigate multiple computer systems and applications to complete reviews and document findings

Requirements

What you’ll need

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
Ability to maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status
Travel requirement: 0-10%

Benefits

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Ongoing training and support
Remote work environment