Medical Reviewer, Optometrist

This is a fully remote position, open to applicants in California.

📋 Description

• Assess optometry-related medical records, claims, Treatment Authorization Requests (TARs), and relevant clinical documentation.

• Analyze requested services in accordance with applicable medical policies, coverage criteria, and clinical standards.

• Utilize professional optometric knowledge to assist in medical necessity and coverage evaluations.

• Accurately and promptly document findings and clinical justifications.

• Forward cases that require further clinical assessment to the appropriate medical professionals.

• Work collaboratively with clinical and operational teams to address review inquiries.

• Stay informed about relevant policies and regulatory standards.

• Achieve established benchmarks for quality, accuracy, productivity, and turnaround times.

• Primarily operate from a home office supporting Medical Review Services for California healthcare programs.

• Function independently while engaging with physicians, nurses, clinical specialists, operations teams, and business partners.

• Navigate various computer systems and applications to complete reviews and document findings.

⛳️ Requirements

• At least one (1) year of experience as an Optometrist.

• Doctor of Optometry degree from an accredited institution.

• Current, valid California license to practice as an Optometrist, in good standing.

• Must not be suspended from Medicare, Medicaid, or practice in California.

• Must not have a prior history of sanctions for fraud or abuse.

• Excellent oral and written communication abilities.

• Strong clinical judgment with the capacity to interpret medical records and relevant clinical documentation.

• Capability to maintain all professional licenses, certifications, and credentials in active, unrestricted, and good-standing status.

• Travel requirement: 0-10%.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Opportunities for continuous learning and career advancement.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.

• Remote work environment.