SummaryThe
Senior Medical Review Manager is a senior healthcare operations leader responsible for overseeing teams of physicians, nurses, and clinical review professionals to ensure high-quality medical necessity reviews, utilization management, and regulatory compliance. The role focuses on driving clinical quality, operational efficiency, workforce planning, budget management, and continuous process improvement while meeting contractual and accreditation standards.
Your role in our mission- Provides strategic leadership and oversight for multidisciplinary teams of physicians, nurses, and clinical review professionals responsible for medical necessity determinations, utilization management, and clinical quality reviews.
- Ensures compliance with applicable regulatory, accreditation, contractual, and organizational requirements governing medical review operations.
- Identifies, develops, and implements process improvements to enhance clinical review quality, consistency, efficiency, and turnaround time performance.
- Collaborates with medical directors, physician reviewers, nursing leadership, and operational teams to forecast workload demand and ensure adequate staffing and resource allocation.
- Monitors clinical review volume, productivity, quality metrics, and service-level performance, implementing corrective actions when required.
- Partners with executive leadership and clinical stakeholders to develop strategic initiatives that improve medical review outcomes and provider satisfaction.
- Develops, manages, and oversees operating, staffing, and departmental budgets, ensuring efficient utilization of resources while meeting performance expectations.
- Oversees workforce planning, including recruitment, retention, succession planning, and professional development for physicians, nurses, and clinical review staff.
- Manages complex relationships with clients, providers, and internal stakeholders to ensure exceptional service delivery and client satisfaction.
- Ensures timely and accurate delivery of medical review services that meet contractual obligations, accreditation standards, and organizational performance expectations.
- Collaborates with clinical and operational leaders to implement new programs, technologies, clinical guidelines, and service offerings that enhance medical review operations.
- Participates in business development activities, including proposal development, operational planning, and presentation of clinical review capabilities to prospective clients.
- Recruits, selects, and retains highly qualified clinical professionals, including physicians, nurses, and pharmacists.
- Provides leadership, coaching, mentoring, and performance management to clinical leadership staff and review teams, fostering a culture of accountability, collaboration, and continuous improvement.
- Evaluates employee performance and clinical review quality, addresses performance concerns, and recommends personnel actions in accordance with company policies and professional standards.
What we're looking for- Master's degree in business administration, engineering, information systems or related field preferred
- Twelve or more years of support services, project, or program experience
- Eight or more years of leadership or supervisory experience
- Experience working with technology industry
- Experience working with company products and operating systems
- Experience working with proposals
What you should expect in this role- United States remote opportunity
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- Must reside in the State of California; Remote Position with semi-occasional in office requirements
- The Deadline to submit applications for this posting is October 24, 2026
#LI-REMOTE#LI-GD1The pay range for this position is $115,900.00 - $165,600.00 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. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
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.
