Associate Manager, Clinical Claim Review

Gainwell Technologies

. Supervise day-to-day prepay, post-pay, prior authorization, and medical record review activities of Coders, Clinical DRG Auditors, and Nurse Reviewers .

Posted 9/28/2026full-timeRemote • United StatesJuniorMid-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 clinical review processes, team leadership, and performance management within healthcare settings. Proficient in analyzing data to enhance service delivery and ensure compliance with clinical criteria and quality metrics.

Highest-signal resume keywords

Active RN LicenseHealthcare Auditing ExperienceUtilization ReviewTeam LeadershipClinical Review Judgment

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical ReviewData AnalysisPerformance ManagementWorkflow OptimizationQuality Metrics Evaluation

Soft Skills

CommunicationMentorshipConflict ResolutionTeam Building

Tools & Technologies

Automation ToolsClinical Review Software

Certifications & Qualifications

CPCCCSCPMA

Industry Keywords

Healthcare AdministrationPrepay ReviewPost-Pay ReviewPrior AuthorizationDRG Auditing

About the role

Key responsibilities & impact

Supervise day-to-day prepay, post-pay, prior authorization, and medical record review activities of Coders, Clinical DRG Auditors, and Nurse Reviewers
Lead the team, assign work, and ensure productivity and quality metrics are achieved
Analyze production and workflow processes to increase efficiency and quality
Communicate changes, build commitment, overcome resistance, support affected staff, and monitor transitions
Oversee and hire staff, retain talent, manage performance, coordinate training and education, and provide leadership and mentorship
Monitor aging inventory, workload, assignments, productivity, and quality against 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 coach and mentor staff
Analyze reports and data to identify trends and resources that improve clinical review service delivery
Manage and evaluate individual and team performance and take action to meet or exceed standards
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

Benefits

Comp & perks

Flexible hours
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