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Job description
Location: Any city, CA, US, 99999
Work Mode: Virtual (Exception only)
It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
The Internal Medical Physician serves as a senior clinical subject matter expert responsible for providing medical oversight and review of healthcare services across a broad range of medical conditions and treatment settings. This role partners with clinical, operational, and client teams to ensure medical necessity determinations are evidence-based, clinically appropriate, and aligned with state Medicaid regulations and program requirements. The Internal Medical Physician supports quality improvement initiatives, provider engagement, policy development, and clinical consultation activities to improve healthcare outcomes and ensure appropriate utilization of services.
Your role in our mission
Serve as the physician subject matter expert for General Medicine and Internal Medicine services within Medicaid and government healthcare programs.
Review complex authorization requests, appeals, and medical necessity determinations across inpatient, outpatient, post-acute, and specialty care settings.
Conduct peer-to-peer consultations with treating providers and apply evidence-based clinical criteria to support appropriate care decisions.
Provide clinical guidance to utilization management, care management, quality improvement, and operational teams.
Interpret and apply Medicaid regulations, medical policies, and nationally recognized clinical guidelines to support program compliance.
Collaborate with clients, providers, and internal stakeholders to improve healthcare outcomes, quality initiatives, and member access to appropriate care.
Support development and maintenance of clinical policies, review guidelines, and utilization management strategies.
Participate in complex case reviews and multidisciplinary discussions involving high-risk or medically complex populations.
What we're looking for
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
Active, unrestricted license to practice medicine in the State of California.
Board Certification in Internal Medicine, Family Medicine, or a related primary care specialty.
Minimum of five years of post-residency clinical practice experience in Internal Medicine, General Medicine, hospital medicine, or related patient care settings.
Strong knowledge of evidence-based medicine, chronic disease management, and care delivery across diverse patient populations.
Experience with Medicaid programs, utilization management, prior authorization, appeals, quality review, or medical necessity determinations preferred.
Knowledge of nationally recognized clinical guidelines and healthcare quality standards.
Excellent analytical, communication, and decision-making skills, with the ability to work independently in a remote environment.
Experience conducting physician peer-to-peer reviews and collaborating with multidisciplinary clinical teams preferred.
What you should expect in this role
Remote within the United States.
Full-time temporary assignment expected to last 9-12 months, with potential for extension based on business needs. Standard schedule: Monday-Friday, 8:00 AM-5:00 PM; flexibility required as needed.
Frequent interaction with physicians, providers, clients, and multidisciplinary healthcare teams.
Review of clinical documentation, utilization management activities, appeals, and quality-of-care assessments.
This is a pipeline requisition. Applications will be reviewed on an ongoing basis.
The pay range for this position is $152,000.00 - $217,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development.
generous, flexible vacation policy
401(k) employer match
comprehensive health benefits
educational assistance
leadership and technical development academies
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
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Worksite address
california, MO, 65018, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.