Remote Associate Manager, Clinical Claim Review

Gainwell Technologies; Northern (KY); Hybrid; USD 76,000 - 90,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Educational assistance

Generous vacation policy

Job summary

Gainwell Technologies is seeking an Associate Manager, Clinical Claim Review for a remote role within the United States. You will supervise a multidisciplinary team handling prepay, post-pay, prior authorization, and medical record reviews, ensuring productivity and quality while implementing efficient workflows.

The role requires strong clinical judgment, leadership experience, and knowledge of utilization review. Travel is up to 20%, with full-time remote work and competitive benefits.

Qualifications

• Active US RN license (single-state or compact multistate) or related coding certification.
• Bachelor's degree in business, healthcare administration, or related field preferred.
• 5+ years healthcare experience with increasing responsibility.
• 3+ years utilization review or healthcare auditing experience preferred.
• 2+ years management or supervisory experience preferred.
• Strong understanding of clinical criteria and 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 metrics.
• Analyze production and workflow to increase efficiency and quality.
• Meet with clients/providers to discuss complex cases and settlements.
• Serve as SME on new tools, automation, and product development; coach staff.

Skills

RN license

Leadership

Healthcare auditing

Utilization review

CPM/CCS/CPMA certs

Education

Bachelor's degree in business or healthcare administration

Job description

Gainwell Technologies is seeking an Associate Manager, Clinical Claim Review for a remote role within the United States. You will supervise a multidisciplinary team handling prepay, post-pay, prior authorization, and medical record reviews, ensuring productivity and quality while implementing efficient workflows.

The role requires strong clinical judgment, leadership experience, and knowledge of utilization review. Travel is up to 20%, with full-time remote work and competitive benefits.