Remote Associate Manager, Clinical Claims Review

Gainwell Technologies LLC; Columbus (OH); Teletrabalho; USD 76 000 - 90 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

401(k) employer match

Comprehensive health benefits

Educational assistance

Resumo da oferta

Gainwell Technologies is seeking an Associate Manager, Clinical Claim Review to supervise a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. You will oversee daily operations, assign work, monitor productivity and quality, and drive process improvements across prepay, post-pay, prior authorization, and medical record review functions.

The role requires an active US RN license (in-state), and relevant credentials (CPC/CCS/CPMA) with 5+ years healthcare experience and

Qualificações

• Active, unrestricted US RN license in primary residence.
• CPC/CCS/CPMA certifications required.
• 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.
• 2+ years of management or supervisory experience.

Responsabilidades

• Oversee day-to-day prepay, post-pay, prior authorization, and medical record review activities.
• Hire, mentor, and manage performance of staff to meet service levels and quality metrics.
• Analyze production data to identify trends and drive efficiency improvements.

Conhecimentos

RN license

Leadership

Mentorship

Formação académica

Bachelor’s degree in business/healthcare

Descrição da oferta de emprego

Gainwell Technologies is seeking an Associate Manager, Clinical Claim Review to supervise a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. You will oversee daily operations, assign work, monitor productivity and quality, and drive process improvements across prepay, post-pay, prior authorization, and medical record review functions.

The role requires an active US RN license (in-state), and relevant credentials (CPC/CCS/CPMA) with 5+ years healthcare experience and