Remote Associate Manager, Clinical Quality (PA)

Gainwell Technologies; Florida; Remote; USD 71,000 - 102,000; Full time

Benefits offered by this job

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies seeks an Associate Manager, Clinical Quality for Prior Authorization. This remote US role leads a team of auditors, ensuring accuracy, timeliness, and regulatory compliance of clinical reviews and authorizations.

You will monitor productivity and quality, drive improvement initiatives, and develop training aligned with CMS, Medicaid, and accreditation standards. Strong leadership, analytics, and healthcare quality expertise are essential.

Qualifications

• Strong analytical, communication, coaching, and problem-solving skills.
• Minimum 5 years of experience in Prior Authorization, utilization management, clinical review, or healthcare quality assurance.
• Minimum 2 years of leadership or quality assurance experience in a health plan, managed care, utilization management, or healthcare setting.
• Current, unrestricted RN license is required; additional utilization management or healthcare quality certification preferred.

Responsibilities

• Supervise the Prior Authorization quality review program, including policies, procedures, and controls supporting compliance with standards, regulations, accreditation requirements, and contracts.
• Develop and maintain quality assurance processes, audit methodologies, and performance benchmarks for medical and behavioral health Prior Authorization reviews.
• Supervise and mentor clinical quality auditors and reviewers through education, coaching, and performance feedback; monitor quality metrics.
• Identify trends, root causes, and improvement opportunities in clinical criteria application, documentation, review consistency, and workflows.
• Analyze audit results, appeals, complaints, and regulatory findings to identify issues and recommend corrective actions.
• Prepare reports and dashboards for leadership on performance, audit outcomes, risks, and improvement initiatives.
• Ensure Prior Authorization reviews are completed accurately, consistently, and within required timeframes.
• Develop and deliver training based on audit findings, policy updates, and performance trends.

Skills

Analytical skills

Communication skills

Coaching

Problem-solving

Leadership

Quality assurance

Education

RN license

Job description

Gainwell Technologies seeks an Associate Manager, Clinical Quality for Prior Authorization. This remote US role leads a team of auditors, ensuring accuracy, timeliness, and regulatory compliance of clinical reviews and authorizations.

You will monitor productivity and quality, drive improvement initiatives, and develop training aligned with CMS, Medicaid, and accreditation standards. Strong leadership, analytics, and healthcare quality expertise are essential.