Medical Reviewer, Podiatrist

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

📋 Description

• Examine medical records related to podiatry, claims, Treatment Authorization Requests (TARs), and relevant clinical documentation.

• Assess requested podiatric services in relation to applicable coverage criteria, medical policies, and clinical standards.

• Utilize professional podiatric knowledge and clinical judgment to determine the medical necessity and appropriateness of services.

• Analyze treatment plans and supporting documents for the requested services.

• Accurately and promptly document clinical findings, review decisions, and the rationale behind them.

• Escalate cases that require further clinical evaluation to the appropriate medical experts.

• Collaborate with physicians, nurses, clinical specialists, operations teams, and business partners to address review inquiries.

• Stay informed about podiatric standards, medical policies, coverage requirements, and regulatory guidelines.

• Achieve quality, accuracy, productivity, and turnaround-time objectives.

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

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

• Travel is expected to be between 0–10%.

⛳️ Requirements

• A minimum of one (1) year of experience in diverse clinical environments is preferred.

• Doctorate or Diploma in Podiatric Medicine, or Diploma in Chiropody.

• Current California State Podiatry license in good standing.

• Strong clinical judgment capabilities.

• Proficiency in interpreting medical records, treatment plans, and related clinical documentation.

• Ability to collaborate effectively with multidisciplinary healthcare teams.

• Excellent written and verbal communication skills.

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

• Proficient in navigating multiple computer systems and applications.

• Ability to meet established quality, accuracy, productivity, and turnaround-time standards.

🏝️ Benefits

• Flexible work hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Ongoing training and support.

• Remote work environment.