Senior Systems/Application/Service Delivery Manager - Utilization Management Domain

Summary

This leadership role is responsible for the day-to-day operations of the Utilization Management (UM) contract and serves as the single point of contact and liaison for client, vendors/contractors and the Gainwell UM product management teams.

Your role in our mission

• Contract Leadership: Responsible for overall UM contract performance (primary contractor and subcontractor) and completion of tasks, quality and timing of deliverables, and compliance with contract requirements
• Stakeholder Relationship/Management: Owe relationship with customer and stakeholders. Oversee all project resources, including Gainwell staff, vendor resources and ensure that appropriate resources are available and performing effectively throughout the contract lifecycle
• Thought Leadership: Develop and maintain executive dashboards and metrics-driven reporting for leadership, highlighting UM program performance, regulatory compliance, and operational KPIs/SLAs
• Outcomes/Results Ownership: Coordinate with Executive Advisory, Medical Leadership, Clinical, Operations, Analytics, QA, Training, and Systems/IT teams to ensure services are performed in accordance with quality and efficiency standards while achieving appropriate contract results/outcomes
• Drive Product Implementation: Liaise with Gainwell product management in developing the product roadmap to meet the customer requirements and ensure the product meets the customer’s quality/regulatory standards
• Compliance/Regulations: Ensure compliance with Medicaid regulations, CMS guidelines, and state-specific requirements throughout the contract lifecycle
• Accountability/Service Delivery: Provide leadership and direction to ensure implementation of service delivery strategies and metrics to continuously improve customer satisfaction. Coordinate delivery timelines and dependencies, proactively managing risks and prioritizing initiatives with stakeholders.
• UM Outcomes: Ensure the data analysis of patterns and trends of utilization of Medicaid services (members, providers, claims, case outcomes, etc.) is conducted to evaluate efficiency of health care delivery, appropriate use of health services and opportunities to improve quality of care
• Governance: Present roadmap, status reports, data analysis patterns etc. to the appropriate customer and internal stakeholders
• People Management: Recruit, train and grow team members
• Travel to the client’s location for meetings, training, and other contract matters as needed.

What we're looking for

• Bachelor's degree in business, health care, engineering, information systems or related field preferred
• 10+ years operations leadership/management experience, preferably in a healthcare or managed care environment
• Minimum of 3-5 years Utilization Management operational and/or Account Management experience
• Knowledge of Utilization Management operational processes (case triaging, call center, mailroom, etc.)
• Understanding of MITA Business Processes, MMIS or Medicaid Enterprise System (MES) DDI, Operations and modularity, Medicaid programs, and CMS Certification Requirements are preferred

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule (40 hours per week).
• Company paid travel for client meetings.
• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• New employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment. Any exception requires manager approval prior to employee's Gainwell start date.
• Company provided computer for work use.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.
• The use of AI during interviews is prohibited.
• This position is for pipelinging. This means we anticipate a position becoming available, but please understand applying does not gurantee an interview.
• This position will accept applications until July 13, 2026.

#LI-NB1

#LI-REMOTE