Note: The job is a remote job and is open to candidates in USA. Gainwell Technologies is seeking a talented individual for the role of Associate Manager, Clinical Review. This position is responsible for supervising the day-to-day activities of a multidisciplinary team involved in clinical claim review, ensuring productivity and quality metrics are achieved while managing operations and analyzing workflows for efficiency improvements.
Responsibilities
- 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
- Meet with clients and providers to discuss complex cases, trend analysis, exit and/or settlement conferences
- 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
Skills
- 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)
- 5+ year's healthcare experience with increasing responsibility required
- 3+ year's utilization review or health care auditing experience required
- Demonstrates a thorough understanding of clinical criteria and clinical review judgment
- Bachelor's degree in business, healthcare administration, or related field preferred
- 2+ year's management or supervisory experience preferred
Benefits
- Generous, flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- A variety of leadership and technical development academies to help build your skills and capabilities
Company Overview