Senior Medical Review Manager

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

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

Senior Medical Review Manager is a senior healthcare operations leader responsible for overseeing teams of physicians, nurses, and clinical review professionals to ensure high-quality medical necessity reviews, utilization management, and regulatory compliance. The role focuses on driving clinical quality, operational efficiency, workforce planning, budget management, and continuous process improvement while meeting contractual and accreditation standards.

Your role in our mission

• 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 applicable 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.
• Collaborates with medical directors, physician reviewers, nursing leadership, and operational teams to forecast workload demand and ensure adequate staffing and resource allocation.
• Monitors clinical review volume, productivity, quality metrics, and service-level performance, implementing corrective actions when required.
• Partners with executive leadership and clinical stakeholders to develop strategic initiatives that improve medical review outcomes and provider satisfaction.
• Develops, manages, and oversees operating, staffing, and departmental budgets, ensuring efficient utilization of resources while meeting performance expectations.
• Oversees workforce planning, including recruitment, retention, succession planning, and professional development for physicians, nurses, and clinical review staff.
• Manages complex relationships with clients, providers, and internal stakeholders to ensure exceptional service delivery and client satisfaction.
• Ensures timely and accurate delivery of medical review services that meet contractual obligations, accreditation standards, and organizational performance expectations.
• Collaborates with clinical and operational leaders to implement new programs, technologies, clinical guidelines, and service offerings that enhance medical review operations.
• Participates in business development activities, including proposal development, operational planning, and presentation of clinical review capabilities to prospective clients.
• Recruits, selects, and retains highly qualified clinical professionals, including physicians, nurses, and pharmacists.
• Provides leadership, coaching, mentoring, and performance management to clinical leadership staff and review teams, fostering a culture of accountability, collaboration, and continuous improvement.
• Evaluates employee performance and clinical review quality, addresses performance concerns, and recommends personnel actions in accordance with company policies and professional standards.

What We're Looking For

• 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

What You Should Expect In This Role

• United States remote opportunity
• Video cameras must be used during all interviews, as well as during the initial week of orientation
• Must reside in the State of California; Remote Position with semi-occasional in office requirements
• The Deadline to submit applications for this posting is October 24, 2026

The pay range for this position is $115,900.00 - $165,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.