Remote Associate Manager, Clinical Quality Lead

Gainwell Technologies LLC; Columbus (OH); Remote; USD 72,000 - 102,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Generous vacation policy

Educational assistance

Job summary

Gainwell Technologies LLC is seeking an Associate Manager, Clinical Quality to lead QA for Prior Authorization reviews. The role supervises a team of auditors, ensures regulatory and contractual compliance, and drives continuous improvement in clinical decision-making and workflows.

The ideal candidate will have an RN license, strong leadership skills, and 5+ years in PA/utilization management. This remote US role offers growth opportunities and a comprehensive benefits package.

Qualifications

• Associate degree required; bachelor’s degree preferred.
• Current, unrestricted RN license required; additional certifications preferred.
• 5+ years in Prior Authorization, utilization management, clinical review, or healthcare quality assurance.
• 2+ years of leadership or quality assurance experience in a health plan or similar setting.
• Strong analytical, communication, coaching, and problem-solving skills.

Responsibilities

• Supervise the Prior Authorization quality review program, including policies, procedures, and controls.
• Develop and maintain QA processes, audit methodologies, and performance benchmarks.
• Mentor clinical quality auditors and reviewers through coaching and feedback.
• Monitor and report quality metrics, productivity, and interrater reliability.
• Identify trends and improvement opportunities in criteria application and workflows.
• Analyze audit results and regulatory findings to drive corrective actions.
• Prepare leadership reports and dashboards on performance and risk.
• Lead quality improvement initiatives to enhance accuracy and efficiency.

Skills

Leadership

Analytical skills

Communication

Coaching

Problem solving

Education

Associate degree required

Bachelor’s degree preferred

Job description

Gainwell Technologies LLC is seeking an Associate Manager, Clinical Quality to lead QA for Prior Authorization reviews. The role supervises a team of auditors, ensures regulatory and contractual compliance, and drives continuous improvement in clinical decision-making and workflows.

The ideal candidate will have an RN license, strong leadership skills, and 5+ years in PA/utilization management. This remote US role offers growth opportunities and a comprehensive benefits package.