Gainwell Technologies

Senior Systems/Application/Service Delivery Manager - Utilization Management Domain

Gainwell Technologies • $108K — $150K *
Wrangell, AK 99929In-Person
Healthcare
Less than 5 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor's degree in business, health care, engineering, or information systems preferred.
  • 10+ years of operations leadership experience, ideally in healthcare or managed care.
  • 3-5 years of specific Utilization Management operational or Account Management experience.
  • Familiarity with Utilization Management processes such as case triaging and call center operations.
  • Knowledge of MITA Business Processes, MMIS or Medicaid Enterprise System (MES) operations is preferred.

Responsibilities

  • Lead overall performance of the Utilization Management (UM) contract and ensure compliance with requirements.
  • Manage relationships with clients and stakeholders, coordinating project resources effectively during the contract lifecycle.
  • Develop executive dashboards and metrics-driven reports to track UM program performance and regulatory compliance.
  • Coordinate with cross-functional teams to ensure quality and efficiency in service delivery per contract specifications.
  • Work with product management on roadmaps to align product quality with customer and regulatory standards.
  • Conduct compliance oversight with Medicaid regulations and CMS guidelines throughout the contract.
  • Drive service delivery strategies and continuously improve customer satisfaction metrics.

Benefits

  • Health benefits (medical, dental, vision) begin on the first day of employment.
  • Company match on 401K and additional benefits available shortly after starting.
  • Access to a flexible vacation policy after 90 days of employment, subject to manager approval.
  • Company-provided computer for work purposes.
  • Company covers travel expenses for client-related activities.
Full Job Description
Summary

This leadership role is responsible for the day-to-day operations of the Utilization Management (UM) contract and serves as the single point of contact and liaison for client, vendors/contractors and the Gainwell UM product management teams.

Your role in our mission

  • Contract Leadership: Responsible for overall UM contract performance (primary contractor and subcontractor) and completion of tasks, quality and timing of deliverables, and compliance with contract requirements
  • Stakeholder Relationship/Management: Owe relationship with customer and stakeholders. Oversee all project resources, including Gainwell staff, vendor resources and ensure that appropriate resources are available and performing effectively throughout the contract lifecycle
  • Thought Leadership: Develop and maintain executive dashboards and metrics-driven reporting for leadership, highlighting UM program performance, regulatory compliance, and operational KPIs/SLAs
  • Outcomes/Results Ownership: Coordinate with Executive Advisory, Medical Leadership, Clinical, Operations, Analytics, QA, Training, and Systems/IT teams to ensure services are performed in accordance with quality and efficiency standards while achieving appropriate contract results/outcomes
  • Drive Product Implementation: Liaise with Gainwell product management in developing the product roadmap to meet the customer requirements and ensure the product meets the customer's quality/regulatory standards
  • Compliance/Regulations: Ensure compliance with Medicaid regulations, CMS guidelines, and state-specific requirements throughout the contract lifecycle
  • Accountability/Service Delivery: Provide leadership and direction to ensure implementation of service delivery strategies and metrics to continuously improve customer satisfaction. Coordinate delivery timelines and dependencies, proactively managing risks and prioritizing initiatives with stakeholders.
  • UM Outcomes: Ensure the data analysis of patterns and trends of utilization of Medicaid services (members, providers, claims, case outcomes, etc.) is conducted to evaluate efficiency of health care delivery, appropriate use of health services and opportunities to improve quality of care
  • Governance: Present roadmap, status reports, data analysis patterns etc. to the appropriate customer and internal stakeholders
  • People Management: Recruit, train and grow team members
  • Travel to the client's location for meetings, training, and other contract matters as needed.


What we're looking for

  • Bachelor's degree in business, health care, engineering, information systems or related field preferred
  • 10+ years operations leadership/management experience, preferably in a healthcare or managed care environment
  • Minimum of 3-5 years Utilization Management operational and/or Account Management experience
  • Knowledge of Utilization Management operational processes (case triaging, call center, mailroom, etc.)
  • Understanding of MITA Business Processes, MMIS or Medicaid Enterprise System (MES) DDI, Operations and modularity, Medicaid programs, and CMS Certification Requirements are preferred


What you should expect in this role

  • This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (40 hours per week).
  • Company paid travel for client meetings.
  • Health (medical, dental, vision) benefits start on day 1 of employment.
  • Company match 401K and other benefits available within months of starting.
  • New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
  • Company provided computer for work use.
  • For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
  • Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
  • The use of AI during interviews is prohibited.
  • This position is for pipelinging. This means we anticipate a position becoming available, but please understand applying does not gurantee an interview.
  • This position will accept applications until July 13, 2026.


#LI-NB1

#LI-REMOTE

The pay range for this position is $108,000 - $150,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

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

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