Gainwell Technologies

Associate Manager, Clinical Review

Gainwell Technologies • $75K — $95K *
Wrangell, AK 99929In-Person
Healthcare
5 - 7 years of experience
2 weeks ago
Job Overview by Ladders

Qualifications

  • Active, unrestricted RN license in the US and primary home residency
  • Bachelor's degree in business, healthcare administration, or related field preferred
  • 5+ years of healthcare experience with increasing responsibility
  • 3+ years of utilization review or healthcare auditing experience
  • 2+ years of management or supervisory experience preferred
  • Understanding of clinical criteria and clinical review judgment

Responsibilities

  • Supervise day-to-day prepay, post-pay, and medical review activities
  • Oversee hiring, retaining talent, and performance management
  • Monitor workload, productivity, and quality to meet service level agreements
  • Evaluate productivity and process for opportunities to improve efficiency
  • Engage with clients and providers on complex cases and trend analysis
  • Serve as Subject Matter Expert for new tools and clinical readiness
  • Analyze data to improve clinical review service delivery
  • Manage team performance to exceed standards

Benefits

  • Remote work opportunity within the US
  • Up to 20% travel required
Full Job Description
Summary

We are seeking a talented individual for an Associate Manager, Clinical Claim Review who is responsible for supervising the day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. Oversees and manages the daily operations of the team by leading, assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow/processes to increase efficiency and quality. Consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; supporting those affected by change; monitoring transition and evaluating results.

Your role in our mission

  • Responsible for oversight and hiring of staff, retaining top talent, performance management, coordinating training and education, and providing leadership and mentorship to staff to build and improve skills to provide best-in-class practices to enhance efficiency, quality, and customer satisfaction.
  • Monitor aging inventory, workload, assignments, productivity, and quality to ensure service level agreements, contract deliverables, and timelines are met.
  • Evaluate and analyze productivity, utilization, efficiency, finding rates, savings, appeal overturn rate, and reviews completed by staff to identify opportunities for process improvements.
  • Meet with clients and providers to discuss complex cases, trend analysis, exit and/or settlement conferences.
  • Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team
  • Analyze reports and data and identify trends and resources that improve the delivery of clinical review services.
  • Manage and evaluate individual/team performance and take appropriate action to meet and/or exceed performance standards.
  • Perform other functions as assigned


What we're looking for

  • Active, Unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Bachelor's degree in business, healthcare administration, or related field preferred
  • 5+ year's healthcare experience with increasing responsibility required
  • 3+ year's utilization review or health care auditing experience required
  • 2+ year's management or supervisory experience preferred
  • Demonstrates a thorough understanding of clinical criteria and clinical review judgment.


What you should expect in this role

  • Remote within the US.
  • Up to 20% Travel


Applications for this posting will be accepted until July 30, 2026.

About Gainwell Technologies

Gainwell Technologies offerings including Medicaid Management Information Systems (MMIS), fiscal agent services, program integrity, care management, immunization registry, and eligibility services. With over 50 years of proven experience, Gainwell carries forward a reputation for technological innovation, service excellence, and unparalleled industry expertise in offering clients scalable and flexible health and human services solutions for their most complex challenges.

Gainwell Technologies Careers

There has never been a more opportune time to join Gainwell Technologies, a leader in providing cutting-edge technology solutions. As a hub of innovation and diversity, Gainwell Technologies offers a plethora of job opportunities aimed at enhancing the digital landscape.

Work You’ll Do

Join Gainwell Technologies' esteemed team to assist some of the most prominent organizations in mastering their technological advancements and digital transformations. At Gainwell Technologies, the focus is on leveraging a unique blend of technology, industry expertise, and digital innovation to lead the market. Professionals at Gainwell Technologies are positioned uniquely at the crossroads of technology and consulting, driving leadership and growth in various sectors through transformative solutions.

Gainwell Technologies Professional Growth and Opportunities

The team is dedicated to building a leading-edge environment that fosters professional growth and innovation. Gainwell Technologies is not just about addressing the current needs of the market but also about foreseeing and shaping the future of technology.

Innovative Work

At Gainwell Technologies, employees engage in groundbreaking work at the intersection of technology and practical application. The company is home to a large group of dedicated professionals who are committed to delivering robust solutions on trusted platforms.

Career Advancement

Embark on a career journey with Gainwell Technologies where the sky is the limit. The company supports ambitious professionals with comprehensive training, development programs, and diverse certification opportunities designed to future-proof careers in the technology sector.

Explore Job Opportunities and Culture

Gainwell Technologies is committed to creating a workplace culture that promotes diversity and inclusion, where every team member’s contribution is valued. Explore various job opportunities, from internships to full-time positions, and become part of a team that values innovation and leadership.

The Gainwell Technologies Commitment to Diversity and Professional Development

Gainwell Technologies recognizes the importance of diversity training and professional development in creating a thriving workplace. The company is dedicated to providing employees with the resources they need to succeed in their careers and contribute to the industry effectively.

Stay Connected with Gainwell Technologies Careers

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Discover open positions that align with your skills and interests. Gainwell Technologies is on the lookout for passionate, curious, and creative professionals who are driven to find solutions and excel in their careers. SEARCH GAINWELL TECHNOLOGIES JOBS

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Learn more about Gainwell Technologies
Size
10,001 employees
Industry
Information Technology
* Ladders Estimates

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