Job Title

Summary We are seeking a talented individual for an Associate Manager, Clinical Claim Review who is responsible for supervising the day-to-day prepay, post-pay, prior authorization, and utilization review activities of a multidisciplinary team of Coders, Clinical DRG Auditors, and Nurse Reviewers. Oversees and manages the daily operations of the team by leading, assigning work, ensuring productivity and quality metrics are achieved, and analyzing production and workflow/processes to increase efficiency and quality. Consistently demonstrates effective change management by communicating changes timely and effectively; building commitment and overcoming resistance; supporting those affected by change; monitoring transition and evaluating results. Your role in our mission Responsible for oversight and hiring of staff, retaining top talent, performance management, coordinating training and education, and providing leadership and mentorship to staff to build and improve skills to provide best-in-class practices to enhance efficiency, quality, and customer satisfaction. Monitor aging inventory, workload, assignments, productivity, and quality to ensure service level agreements, contract deliverables, and timelines are met. Evaluate and analyze productivity, utilization, efficiency, finding rates, savings, appeal overturn rate, and reviews completed by staff to identify opportunities for process improvements. 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 Analyze reports and data and identify trends and resources that improve the delivery of clinical review services. Manage and evaluate individual/team performance and take appropriate action to meet and/or exceed performance standards. Perform other functions as assigned What we’re looking for 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), required 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. What you should expect in this role Remote (Work from Home) Up to 20% Travel Applications for this posting will be accepted until November 25, 2025. #LI-AC1 #LI-REMOTE The pay range for this position is$80,000.00-$99,000.00 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 , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.