Remote Clinical Claims Review Manager

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

Job summary

Gainwell Technologies LLC is seeking an Associate Manager, Clinical Claim Review to supervise day-to-day activities of a multidisciplinary team including Coders, DRG Auditors, and Nurse Reviewers. You will lead, assign work, monitor productivity and quality, and drive process improvements to deliver best-in-class clinical review services.

This remote US role offers full-time employment with up to 20% travel.

Qualifications

• Active, Unrestricted RN license in the United States.
• Active compact multistate RN license (NLC) or CPC/CCS/CPMA 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.
• Demonstrates thorough understanding of clinical criteria and clinical review judgment.

Responsibilities

• Oversee day-to-day prepay, post-pay, prior authorization, and medical record review activities.
• Lead a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers.
• Manage staffing, training, and performance to build a high-performing team.
• Monitor productivity, quality metrics, and service levels; drive improvements.
• Meet with clients and providers to discuss complex cases and trends.
• Act as SME for new tools, automation, and product development; coach staff.

Skills

RN license

Healthcare auditing

Management

Clinical criteria understanding

Education

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

Job description

Gainwell Technologies LLC is seeking an Associate Manager, Clinical Claim Review to supervise day-to-day activities of a multidisciplinary team including Coders, DRG Auditors, and Nurse Reviewers. You will lead, assign work, monitor productivity and quality, and drive process improvements to deliver best-in-class clinical review services.

This remote US role offers full-time employment with up to 20% travel.