Gainwell Technologies

Medical Reviewer

• Review speech, language, and audiology-related claims, Treatment Authorization Requests (TARs), treatment plans, and clinical documentation
• Evaluate requested services based on applicable medical policies, coverage requirements, and professional standards
• Apply speech-language pathology or audiology expertise to support medical necessity and appropriateness determinations
• Review treatment plans and supporting documentation for requested or billed services
• Document review findings, decisions, and supporting clinical rationale accurately and timely
• Refer cases requiring additional clinical review to appropriate medical professionals when needed
• Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners to resolve review questions
• Maintain knowledge of applicable professional standards, medical policies, coverage requirements, 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
• Support Medical Review Services for California healthcare programs

Medical Reviewer – Speech and Audiology Specialist

• Review radiology-related claims, Treatment Authorization Requests (TARs), medical records, and supporting clinical documentation
• Evaluate imaging and radiology services based on applicable medical policies, coverage requirements, and clinical standards
• Provide physician-level medical review and clinical expertise for complex radiology cases
• Support medical necessity and appropriateness determinations for requested or billed radiology services
• Document review findings, decisions, and supporting clinical rationale clearly and accurately
• Refer or collaborate on cases requiring additional clinical expertise when appropriate
• Collaborate with physicians, nurses, other clinical specialists, operations teams, and business partners
• Maintain knowledge of applicable radiology standards, medical policies, coverage requirements, and regulatory guidelines
• Meet established quality, accuracy, productivity, and turnaround-time expectations
• Work primarily from a home office supporting Medical Review Services for California healthcare programs
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations

Medical Reviewer, Radiologist

• 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

Medical Reviewer – Prosthetic and Orthotic Devices Specialist

• Review podiatry-related medical records, claims, Treatment Authorization Requests (TARs), and supporting clinical documentation
• Evaluate requested podiatric services against applicable coverage requirements, medical policies, and clinical standards
• Apply professional podiatric expertise and clinical judgment to review medical necessity and appropriateness of services
• Review treatment plans and supporting documentation for requested services
• Document clinical findings, review decisions, and supporting rationale accurately and timely
• Refer cases requiring additional clinical review to appropriate medical professionals
• Collaborate with physicians, nurses, clinical specialists, operations teams, and business partners to resolve review questions
• Maintain knowledge of podiatric standards, medical policies, coverage requirements, and regulatory guidelines
• Meet quality, accuracy, productivity, and turnaround-time expectations
• Work primarily from a home office supporting Medical Review Services for California healthcare programs
• Navigate multiple computer systems and applications to complete reviews and document findings
• Travel 0–10%

Medical Reviewer, Podiatrist

• Review and interpret medical records and clinical documentation to determine medical necessity and appropriateness of healthcare services
• Provide clinical review support for Treatment Authorization Requests (TARs) and other authorization activities
• Support medical review activities related to medical policy, claim adjudication, drug utilization review, and other healthcare program requirements
• Apply professional nursing principles, clinical judgment, medical policies, and established utilization guidelines when completing reviews
• Review documentation to determine whether requested services, procedures, supplies, and equipment meet coverage and clinical requirements
• Document review findings, decisions, and supporting clinical rationale accurately and timely
• Determine approvals within established guidelines or refer cases to physicians or other appropriate clinical professionals
• Apply knowledge of hospital routines, medical services, medical supplies, and appropriate clinical uses
• Collaborate with physicians, pharmacists, nurses, and other healthcare professionals
• Maintain current knowledge of clinical criteria, medical policies, procedures, 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
• Navigate multiple systems and applications to complete reviews and document findings

Medical Reviewer, Registered Nurse

• Review physical therapy-related medical records, claims, Treatment Authorization Requests (TARs), treatment plans, and supporting documentation
• Evaluate requested therapy services based on clinical documentation, medical policy, and applicable coverage requirements
• Apply professional physical therapy principles and clinical judgment when supporting medical necessity and appropriateness determinations
• Document review findings and clinical rationale accurately and timely
• Refer cases requiring additional clinical review to appropriate medical professionals when needed
• Collaborate with physicians, nurses, therapists, operations teams, and other healthcare professionals to resolve review questions
• Maintain knowledge of applicable physical therapy standards, medical policies, coverage requirements, and regulatory guidelines
• Meet established quality, accuracy, productivity, and turnaround-time expectations
• Work primarily from a home office while supporting Medical Review Services for California healthcare programs
• Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations

Medical Reviewer – Physical Therapist

• 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

Medical Reviewer, Optometrist

Full-stack Engineer

• Design, develop, and maintain Java/Spring Boot applications and REST APIs
• Use AI tools such as GitHub Copilot and CodeX to accelerate development, testing, documentation, and code reviews
• Develop configurable workflows, business rules, reporting, and user-facing functionality
• Create and maintain automated unit, integration, and regression tests
• Collaborate with Product, QA, Architecture, and Business teams to deliver healthcare and public health solutions
• Participate in modernization initiatives and adoption of AI-driven engineering practices
• Ensure code quality, security, performance, and maintainability
• Design, build, and train machine learning and deep learning models, including GenAI, NLP, and predictive analytics solutions
• Develop, test, and deploy AI solutions in cloud and on-premises environments
• Process large healthcare datasets, including data preprocessing, feature engineering, and model training
• Ensure compliance with HIPAA, healthcare regulations, ethical AI principles, and data privacy standards
• Integrate and optimize AI models within Gainwell’s existing technology stack
• Research AI/ML advancements and explore new technologies and methodologies
• Identify opportunities to automate workflows and optimize business processes using AI-driven solutions

AI Software Engineer

Manager

• Define program goals, success metrics, and long-term strategy with business and technical stakeholders
• Translate organizational objectives into actionable program roadmaps and execution plans
• Coordinate multiple related projects for aligned and cohesive delivery
• Oversee end-to-end program delivery from initiation through completion
• Develop and maintain program plans, schedules, and resource allocations
• Monitor progress, identify issues, and implement mitigation strategies
• Ensure high-quality deliverables meet program requirements and standards
• Facilitate communication across engineering, operations, business, and leadership teams
• Lead steering committee updates, program reviews, and executive reporting
• Manage stakeholder expectations and drive alignment across diverse groups
• Identify, evaluate, and track risks, dependencies, and blockers
• Lead problem resolution efforts
• Drive change management and adoption of new processes or technologies
• Drive continuous improvement across programs, processes, and tools
• Build repeatable frameworks, templates, and governance models
• Develop KPIs, dashboards, and reporting mechanisms to measure program outcomes

Experienced Portfolio Manager

Customer Support

• Provide daily leadership, coaching, guidance, and support to customer service representatives
• Reinforce performance and service expectations
• Assist with complex customer inquiries, escalations, system navigation, and case resolution
• Monitor productivity, quality, schedule adherence, documentation, and other performance indicators
• Partner with Operations, Quality, Training, Workforce Management, and other teams to resolve service issues
• Support onboarding, employee development, process updates, knowledge sharing, and continuous improvement initiatives
• Collaborate with leadership and program stakeholders in a geographically dispersed customer service operation

Customer Support Team Lead

Customer Success Manager

• Lead daily operations for a remote team of Contact Center Agents and/or Unit Leads
• Ensure productivity, quality, documentation, and service expectations are consistently achieved
• Coach, mentor, and develop employees through feedback, performance discussions, team meetings, and individualized development support
• Monitor customer outreach, verification activities, escalations, follow-up work, service metrics, and operational trends
• Identify and resolve performance or process gaps
• Partner with Operations, Quality, Workforce Management, Training, Reporting, and other internal stakeholders
• Improve service delivery and operational effectiveness
• Support onboarding, training reinforcement, procedural updates, workload management, and continuous improvement initiatives

Customer Engagement Verification Supervisor

Procurement

• Draft, review, negotiate, and manage state agreements, including MSAs, SOWs, amendments and change orders, NDAs, teaming agreements, software/SaaS and technology agreements, vendor and subcontractor agreements, and healthcare-related services agreements
• Lead contract negotiations with customers, vendors, subcontractors, and business partners
• Analyze contractual risks and recommend risk-mitigation strategies to management
• Interpret contract provisions and guide internal legal and contracts teams on rights, obligations, and compliance requirements
• Collaborate with U.S.-based contract managers, attorneys, and business leaders to resolve legal, commercial, operational, and compliance issues
• Support bid and procurement activities, including proposal and contract reviews for RFPs and government healthcare opportunities
• Ensure contracts comply with corporate policies, applicable laws, healthcare regulations, privacy requirements, and contracting standards
• Maintain accurate contract records in contract lifecycle management systems
• Track contractual obligations, deliverables, renewals, notices, and expiration dates
• Provide training and guidance on contract processes and risk management
• Build relationships with business partners and serve as a trusted advisor

Contract Management Lead

Compliance

• Draft, review, negotiate, and manage MSAs, SOWs, amendments and change orders, NDAs, teaming agreements, software/SaaS/technology agreements, vendor and subcontractor agreements, and healthcare-related services agreements
• Lead contract negotiations with customers, vendors, subcontractors, and business partners
• Analyze contractual risks and develop risk-mitigation strategies
• Interpret contract provisions and advise legal, contracts, and business stakeholders on rights, obligations, and compliance requirements
• Collaborate with U.S.-based contract managers, attorneys, and business leaders to resolve legal, commercial, operational, and compliance issues
• Support proposal, bid, and procurement activities, including contract reviews for RFPs and government healthcare opportunities
• Manage contracts for compliance with corporate policies, applicable laws, healthcare regulations, privacy requirements, and contracting standards
• Maintain accurate contract records using contract lifecycle management systems
• Track contractual obligations, deliverables, renewals, notices, and expiration dates
• Train and guide internal stakeholders on contract processes and risk management

Senior Contract & Compliance Specialist

Pharmacist

• Ensure compliance with state and federal regulations, including Medicaid requirements
• Conduct clinical evaluations of medication therapy, including prior authorization reviews and drug utilization assessments
• Perform peer-to-peer consultations with providers
• Support prescriber outreach for identified clinical interventions
• Provide clinical guidance to call center teams
• Support pharmacy-related inquiries and escalations
• Contribute to quality improvement initiatives, program optimization, and development of best practices
• Support state meetings and assist with state-required deliverables related to account operations
• Advise on clinical policies, drug utilization, and pharmacy operations
• Align pharmacy strategies with regulatory requirements and organizational objectives

Pharmacist, Advisor

Software Engineer

• Perform design, development, and testing activities
• Support the full life cycle of development processes for creating services
• Investigate and resolve complex business and technical product integration matters
• Focus on a specific product or family of technologies across multiple platforms
• Influence technical decisions during various project phases
• Code, test, debug, implement, and document programs
• Modify company products and customer/internal systems to meet client and end-user needs
• Gather system information, analyze program and time requirements, and prepare documentation for program changes
• Research and analyze existing systems and program requirements
• Design programs for projects or enhancements to existing programs
• Write specifications for low- to moderate-complexity programs
• Assist in resolving production support problems
• Develop alternative approaches to resolving problems
• Develop test plans to verify logic of new or modified programs
• Identify issues and create program code and technical documentation
• Conduct quality assurance activities such as peer reviews