California Licensed Medical Reviewer

Job Summary

Providing subject-matter expertise in a remote full-time capacity, the California Licensed Medical Reviewer (Prosthetic and Orthotic Devices Specialist) will review claims, Treatment Authorization Requests (TARs), and prescriptions related to prosthetic and orthotic devices to ensure compliance with medical necessity and program requirements.

Key responsibilities

• Review claims, TARs, and supporting documentation for prosthetic and orthotic devices
• Evaluate requests based on coverage requirements and medical policies
• Document review findings and collaborate with clinical and operational teams

Required qualifications

• Professional experience as a Prosthetic and Orthotic practitioner
• Certification in Prosthetics and Orthotics
• Ownership or management experience in a Prosthetic and Orthotic business preferred
• Strong knowledge of prosthetic and orthotic devices and clinical applications
• Ability to interpret medical documentation and prescriptions