Associate Manager, Clinical Claim Review- Remote

Gainwell Technologies LLC; Fulton (MS); Remote; USD 76,000 - 90,000; Full time

Benefits offered by this job

Educational assistance

Leadership and technical development

Flexible vacation policy

Job summary

Gainwell Technologies seeks an Associate Manager, Clinical Claim Review to lead a multidisciplinary team responsible for prepay, post-pay, prior authorization, and medical record review activities. You will supervise staff, drive productivity and quality, and implement improvements across workflow and processes.

The role requires an active US RN license or equivalent, 5+ years healthcare experience, and 2+ years of management.

Qualifications

• RN license (Active, Unrestricted) from US with primary residence.
• Bachelor’s degree in business, healthcare administration, or related field preferred.
• 5+ years healthcare experience with increasing responsibility.
• 3+ years utilization review or health care auditing experience preferred.
• 2+ years management or supervisory experience preferred.
• Understanding of clinical criteria and clinical review judgment.

Responsibilities

• Oversee day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team.
• Lead, assign work, monitor productivity and quality to meet SLAs and timelines.
• Analyze production workflows to improve efficiency and quality.
• Provide change management, communicate changes, and support staff through transitions.
• Meet with clients and providers to discuss complex cases and trend analyses.
• Act as SME to assess new tools, automation, product development, and clinical readiness; coach staff.
• Analyze reports to identify trends and resources to improve clinical review delivery.
• Manage and evaluate performance, taking action to meet/exceed standards.
• Perform other functions as assigned.

Education

Bachelor’s degree in business, healthcare administration, or related field

Job description

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

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) or Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA) required
• 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 preferred
• 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

• Work Arrangement: Remote within the United States.
• Position Type: Full-time position.
• Travel: Up to 20%

Will accept applications until October 30, 2026.

The pay range for this position is $76,400.00 - $90,000.00 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 , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

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."