Remote Lead, Clinical Claims Review

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

Benefits offered by this job

Educational assistance

Leadership and technical development

Flexible vacation policy

Job summary

Gainwell Technologies seeks an Associate Manager, Clinical Claim Review to lead a multidisciplinary team responsible for prepay, post-pay, prior authorization, and medical record review activities. You will supervise staff, drive productivity and quality, and implement improvements across workflow and processes.

The role requires an active US RN license or equivalent, 5+ years healthcare experience, and 2+ years of management.

Qualifications

• RN license (Active, Unrestricted) from US with primary residence.
• Bachelor’s degree in business, healthcare administration, or related field preferred.
• 5+ years healthcare experience with increasing responsibility.
• 3+ years utilization review or health care auditing experience preferred.
• 2+ years management or supervisory experience preferred.
• Understanding of clinical criteria and clinical 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 to meet SLAs and timelines.
• Analyze production workflows to improve efficiency and quality.
• Provide change management, communicate changes, and support staff through transitions.
• Meet with clients and providers to discuss complex cases and trend analyses.
• Act as SME to assess new tools, automation, product development, and clinical readiness; coach staff.
• Analyze reports to identify trends and resources to improve clinical review delivery.
• Manage and evaluate performance, taking action to meet/exceed standards.
• Perform other functions as assigned.

Education

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

Job description

Gainwell Technologies seeks an Associate Manager, Clinical Claim Review to lead a multidisciplinary team responsible for prepay, post-pay, prior authorization, and medical record review activities. You will supervise staff, drive productivity and quality, and implement improvements across workflow and processes.

The role requires an active US RN license or equivalent, 5+ years healthcare experience, and 2+ years of management.