Remote Senior Medical Review Leader

Gainwell Technologies; California; Hybrid; USD 116,000 - 166,000; Full time

Benefits offered by this job

401(k) match

Health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies seeks a Senior Medical Review Manager in California to lead multidisciplinary teams delivering medical necessity determinations and utilization management. The role ensures regulatory and contractual compliance while driving quality and efficiency in clinical review operations.

The position oversees budgeting, staffing, and professional development, collaborating with executives and clinical stakeholders to improve outcomes and provider satisfaction.

Qualifications

• Five or more years of support services, project, or program experience.
• Five or more years of leadership or supervisory experience.
• Experience working with technology industry.
• Experience working with company products and operating systems.
• Experience working with proposals.

Responsibilities

• Provides strategic leadership and oversight for multidisciplinary teams of physicians, nurses, and clinical review professionals responsible for medical necessity determinations, utilization management, and clinical quality reviews.
• Ensures compliance with regulatory, accreditation, contractual, and organizational requirements governing medical review operations.
• Identifies, develops, and implements process improvements to enhance clinical review quality, consistency, efficiency, and turnaround time performance.
• Forecasts workload demand and ensures adequate staffing and resource allocation with medical directors and nursing leadership.
• Monitors volume, productivity, quality metrics, and service-level performance, taking corrective actions when required.

Skills

Leadership experience

Support services

Tech industry exposure

Proposals experience

Experience with company products

Job description

Gainwell Technologies seeks a Senior Medical Review Manager in California to lead multidisciplinary teams delivering medical necessity determinations and utilization management. The role ensures regulatory and contractual compliance while driving quality and efficiency in clinical review operations.

The position oversees budgeting, staffing, and professional development, collaborating with executives and clinical stakeholders to improve outcomes and provider satisfaction.