Associate Manager, Clinical Claim Review

Gainwell Technologies

. Supervise day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team .

Posted 10/7/2026full-timeRemote • United StatesMid-Level💰 $76,400 - $90,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare management, including supervision of multidisciplinary teams, performance evaluation, and clinical review processes. Proficient in utilizing data analysis to enhance operational efficiency and quality metrics while providing leadership and mentorship in a remote work environment.

Highest-signal resume keywords

Active RN LicenseHealthcare Auditing ExperienceUtilization ReviewManagement ExperienceClinical Review Judgment

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Healthcare ExperienceData AnalysisPerformance ManagementQuality MetricsWorkflow AnalysisClinical Criteria UnderstandingMentorshipCoachingTrend AnalysisEscalated Issue Resolution

Soft Skills

LeadershipCommunicationTeam ManagementProblem-SolvingOrganizational Change Management

Tools & Technologies

Automation ToolsClinical Readiness Tools

Certifications & Qualifications

CPCCCSCPMA

Industry Keywords

Healthcare AdministrationUtilization ReviewClinical ReviewPerformance MetricsService Level Agreements

About the role

Key responsibilities & impact

Supervise day-to-day prepay, post-pay, prior authorization, and medical record review activities of a multidisciplinary team
Lead, assign work, and ensure productivity and quality metrics are achieved
Analyze production and workflows to increase efficiency and quality
Communicate and manage organizational changes effectively
Oversee hiring, retention, performance management, training, and education
Provide leadership, mentorship, and coaching to Coders, Clinical DRG Auditors, and Nurse Reviewers
Monitor aging inventory, workload, assignments, productivity, quality, service level agreements, contract deliverables, and timelines
Evaluate productivity, utilization, efficiency, finding rates, savings, appeal overturn rates, and completed reviews
Meet with clients and providers regarding complex cases, trend analysis, exit conferences, and settlement conferences
Serve as a subject matter expert for new tools, automation, product development, and clinical readiness
Resolve escalated issues and analyze reports and data to identify trends and resources
Manage and evaluate individual and team performance and take appropriate action
Perform other assigned functions

Requirements

What you’ll need

Active, unrestricted RN license from the United States and in the primary home residency, active compact multistate unrestricted RN license under the Nurse Licensure Compact (NLC), or CPC, CCS, or CPMA certification required
Bachelor's degree in business, healthcare administration, or related field preferred
5+ years of healthcare experience with increasing responsibility required
3+ years of utilization review or healthcare auditing experience preferred
2+ years of management or supervisory experience preferred
Thorough understanding of clinical criteria and clinical review judgment
Ability to work remotely within the United States
Ability to travel up to 20%

Benefits

Comp & perks

Flexible hours/work flexibility
Work-life balance
Continuous learning and career development
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies
Up to 20% travel