Associate Manager, Clinical Quality

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a talented individual for an Associate Manager, Clinical Quality position who will be responsible for supervising Quality Assurance activities for Coding and DRG Validation reviews. The Associate Manager of Clinical Quality plays an integral role in ensuring the accuracy, integrity, and compliance of clinical and coding review activities. This role is responsible for leading a team of clinical auditors and coding professionals to validate DRG assignments, monitor audit quality, identify trends, and drive improvement initiatives that support accurate reimbursement, regulatory compliance, and data integrity. The Associate Manager also oversees and manages the daily operations of the team by leading and assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow processes to increase efficiency and quality. This individual consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; supporting those affected by change; and monitoring transitions and evaluating results. 

Your role in our mission

• Supervise the quality review program, creating policies and processes relating to quality and ensuring continuous conformance with appropriate standards, regulations, and contractual agreements.
• Develop, implement, and maintain quality assurance processes and performance benchmarks for DRG validation, inpatient coding, and outpatient coding/billing audits.
• Supervise and mentor clinical auditors and coding specialists; provide education, coaching, and performance feedback.
• Monitor and report key performance indicators (KPIs) for audit accuracy, productivity, and interrater reliability.
• Identify trends, root causes, and opportunities for improvement in documentation or coding accuracy.
• Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions.
• Prepare and present regular reports and dashboards for leadership, highlighting performance metrics, audit outcomes, and improvement initiatives.
• Support compliance and revenue integrity efforts by ensuring the accuracy of coded data used for reimbursement, quality reporting, and analytics.
• Develop and deliver training programs for coding, clinical, and quality assurance teams.
• Stay current with evolving CMS regulations, ICD-10-CM/PCS updates, and industry standards for inpatient coding and DRG assignment.
• Drive continuous quality improvement initiatives to enhance effectiveness and efficiency.
• Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team.
• Manage and evaluate individual and team performance, and take appropriate action to meet and/or exceed performance standards.
• Perform other functions as assigned.

What we’re looking for

• Associate degree required; bachelor’s degree preferred.
• Unrestricted RN license and one of the following preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), RHIT, RHIA, or Certified Professional Medical Auditor (CPMA).
• Working knowledge of the application of current official coding guidelines and Coding Clinic citations.
• Demonstrates a thorough understanding of APR-DRG, MS-DRG, ICD-10, clinical criteria, and clinical review judgment.
• Minimum of 5 years of experience in inpatient/outpatient coding, clinical documentation improvement, or DRG validation auditing.
• Minimum of 2 years of leadership or quality assurance experience in a healthcare or health information management setting.

What you should expect in this role

• Work Arrangement: Remote within the United States.
• Position Type: Full-time position.
• Travel: Up to 20%

Applications for this posting will be accepted until November 25, 2025.

The pay range for this position is $64,800.00 - $92,600.00 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.