Associate Manager, Clinical Review

🕒 June 17

🤠 Texas – Remote

🤠 Texas – Remote

💵 $94k - $109.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

🦅 H1B Visa Sponsor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Healthcare Insurance • Human Services • Healthcare

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Responsible for supervising the day-to-day prepay, post-pay, prior authorization, and medical record review activities • Oversees and manages the daily operations of the team by leading, assigning work, ensuring productivity and quality metrics are achieved • Analyzing production and workflow/processes to increase efficiency and quality • Responsible for oversight and hiring of staff, retaining top talent, performance management • Coordinating training and education • Building and improving skills to provide best-in-class practices to enhance efficiency, quality, and customer satisfaction • Monitor aging inventory, workload, assignments, productivity, and quality • Evaluate and analyze productivity and identify opportunities for process improvements • Meet with clients and providers to discuss complex cases • Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness • Analyze reports and data and identify trends and resources that improve the delivery of clinical review services.

🎯 Requirements

• Active, Unrestricted RN license from the United States and in the primary home residency • active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) • Bachelor’s degree in business, healthcare administration, or related field preferred • 5+ year’s healthcare experience with increasing responsibility required • 3+ year’s utilization review or health care auditing experience required • 2+ year’s management or supervisory experience preferred • Demonstrates a thorough understanding of clinical criteria and clinical review judgment.

🏖️ Benefits

• generous, flexible vacation policy • 401(k) employer match • comprehensive health benefits • educational assistance • leadership and technical development academies