Medical Reviewer – Prosthetic and Orthotic Devices Specialist

Gainwell Technologies

Medical Reviewer evaluating prosthetic and orthotic device claims for Gainwell’s California healthcare programs. Reviewing medical necessity, coverage, authorizations, and supporting documentation.

Posted 8/22/2026full-timeRemote • California • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in evaluating and reviewing prosthetic and orthotic requests, ensuring compliance with medical policies and standards. Proficient in documentation analysis and collaboration with clinical and operational teams to support timely claim adjudication.

Highest-signal resume keywords

Prosthetic And Orthotic CertificationProsthetic And Orthotic Device KnowledgeMedical Documentation InterpretationAnalytical SkillsCollaboration With Cross-Functional Teams

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewTreatment Authorization Requests (TARs)Documentation AssessmentProsthetic And Orthotic Equipment ExpertiseClaim Adjudication SupportRegulatory Guidelines KnowledgeQuality And Productivity StandardsComputer Systems Navigation

Soft Skills

Strong Written CommunicationStrong Verbal CommunicationAnalytical ThinkingIndependent Work Ability

Certifications & Qualifications

Certification In Prosthetics And Orthotics

Industry Keywords

Prosthetic And Orthotic ServicesMedical PoliciesProfessional StandardsCoverage RequirementsClinical Applications

About the role

Key responsibilities & impact

Review claims, Treatment Authorization Requests (TARs), prescriptions, and supporting documentation involving prosthetic and orthotic devices
Evaluate prosthetic and orthotic requests based on applicable coverage requirements, medical policies, and professional standards
Assess documentation supporting the medical need and appropriate use of prosthetic and orthotic devices
Provide subject-matter expertise related to prosthetic and orthotic equipment, services, and practices
Support claim adjudication and authorization activities involving prosthetic and orthotic services
Document review findings, decisions, and supporting rationale accurately and timely
Identify documentation or coverage issues requiring additional review or clarification
Collaborate with clinicians, providers, operations teams, and other Medical Review Services specialists
Maintain knowledge of applicable prosthetic and orthotic standards, coverage requirements, policies, and regulatory guidelines
Meet established quality, accuracy, productivity, and turnaround-time expectations
Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations

Requirements

What you’ll need

Professional experience as a Prosthetic and Orthotic (P&O) practitioner consistent with program requirements
Certification in Prosthetics and Orthotics
Ownership or management of a Prosthetic and Orthotic business within the past five (5) years preferred
Strong knowledge of prosthetic and orthotic devices, services, and clinical applications
Ability to interpret medical documentation, prescriptions, and supporting device information
Strong analytical, written, and verbal communication skills
Ability to work independently while collaborating effectively with clinical, operational, and cross-functional teams
Maintain all professional certifications and credentials required for the position in active and good-standing status, as applicable

Benefits

Comp & perks

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