Senior Medical Review Manager

Gainwell Technologies

. Provide strategic leadership and oversight for multidisciplinary teams of physicians, nurses, and clinical review professionals responsible for medical necessity determinations, utilization management, and clinical quality reviews .

Posted 9/21/2026full-timeCalifornia • United StatesSenior💰 $115,900 - $165,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strategic leadership in managing multidisciplinary teams, ensuring compliance with regulatory standards, and implementing process improvements to enhance clinical review quality and efficiency. Proven ability to manage budgets, workforce planning, and client relationships while driving initiatives for improved medical review outcomes.

Highest-signal resume keywords

Strategic LeadershipUtilization ManagementProcess ImprovementBudget ManagementRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity DeterminationClinical Quality ReviewWorkload ForecastingPerformance ManagementProject Management

Soft Skills

CoachingMentoringRelationship ManagementTeam Leadership

Tools & Technologies

Clinical GuidelinesService OfferingsProposal Development

Industry Keywords

HealthcareClinical ReviewUtilization ManagementAccreditationCalifornia Residency

About the role

Key responsibilities & impact

Provide strategic leadership and oversight for multidisciplinary teams of physicians, nurses, and clinical review professionals responsible for medical necessity determinations, utilization management, and clinical quality reviews
Ensure compliance with regulatory, accreditation, contractual, and organizational requirements
Identify, develop, and implement process improvements to improve clinical review quality, consistency, efficiency, and turnaround time
Forecast workload demand and ensure adequate staffing and resource allocation
Monitor clinical review volume, productivity, quality metrics, and service-level performance, implementing corrective actions as needed
Develop strategic initiatives to improve medical review outcomes and provider satisfaction
Manage operating, staffing, and departmental budgets
Oversee workforce planning, recruitment, retention, succession planning, and professional development
Manage relationships with clients, providers, and internal stakeholders
Ensure timely and accurate delivery of medical review services
Implement new programs, technologies, clinical guidelines, and service offerings
Participate in business development, proposal development, operational planning, and presentations
Recruit, select, and retain physicians, nurses, pharmacists, and other clinical professionals
Provide leadership, coaching, mentoring, and performance management
Evaluate employee performance and clinical review quality and address performance concerns

Requirements

What you’ll need

Master's degree in business administration, engineering, information systems or related field preferred
Twelve or more years of support services, project, or program experience
Eight or more years of leadership or supervisory experience
Experience working with technology industry
Experience working with company products and operating systems
Experience working with proposals
Must reside in the State of California
Video cameras must be used during all interviews and during the initial week of orientation

Benefits

Comp & perks

Work flexibility
Learning and career development opportunities
Technical credentials and certifications
Generous, flexible vacation policy
Educational assistance
Leadership and technical development academies
401(k) employer match
Comprehensive health benefits