Manager, Clinical Review - Remote

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 a Manger of Clinical Review to provide leadership and management for our clinical claim review teams which include: Utilization Management, Utilization Review, Prior Authorization, Coding and DRG Validation to ensure that contract goals are achieved and quality of service is maintained.

Your role in our mission

• Oversees clinical claim review activities for assigned accounts to maximize team performance, meet or exceed contractual obligations, and deliver customer satisfaction consistent with established operating policies and procedures.
• Continually works to improve efficiency, productivity, quality, and reduce operational costs. 
• Works with the Medical Director and Clinical Policy team, to develop internal review guidelines, clinical review processes and procedures to ensure compliance with client deliverables while maintaining high quality and performance standards across all contracts.
• In coordination with the Quality Management Committee, develops and maintains quality policies and standards to ensure compliance with Utilization Review Accreditation Committee (URAC) accreditation requirements.
• Serves as the SME in evaluating new business opportunities, responding to requests for proposal, and implementing new clients or products.

What we’re looking for

• Bachelor’s degree in Nursing, Healthcare Administration, Business Administration, or related field required
• 10+ year’s healthcare/insurance experience with increasing responsibility required
• 3+ year’s management or supervisory experience required

What you should expect in this role

• Remote (Work from Home)
  • In order to effectively work as a remote worker (work from home) with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload.  Greater speeds will of course provide better performance.
  • To Test your internet download and upload speed:
  • Go to Google.
  • Search for Internet Speed Test or click here.  
• Up to 20% Travel
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

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The pay range for this position is $82,700.00 - $118,100.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.