Location: USA
more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a talented individual for a Manger of Clinical Review to provide leadership and management for our clinical claim review teams which include: Utilization Management, Utilization Review, Prior Authorization, Coding and DRG Validation to ensure that contract goals are achieved and quality of service is maintained.
Your role in our mission Oversees clinical claim review activities for assigned accounts to maximize team performance, meet or exceed contractual
obligations, and deliver customer satisfaction consistent with established operating policies and procedures. Continually works to improve efficiency, productivity, quality, and reduce operational costs.
Works with the Medical Director and Clinical Policy team, to develop internal review guidelines, clinical review processes and procedures to ensure compliance with client deliverables while maintaining high quality and performance standards across all contracts. In coordination with the Quality Management Committee, develops and maintains quality policies and standards to ensure compliance with Utilization Review Accreditation Committee (URAC) accreditation requirements. Serves as the
SME in evaluating new business opportunities, responding to requests for proposal, and implementing new clients or products.
What we’re looking for Bachelor’s degree in Nursing, Healthcare Administration, Business Administration, or related field required 10+ year’s healthcare/insurance experience with increasing responsibility required 3+ year’s management or supervisory experience required What you should expect in this role Remote (Work from Home) In order to effectively work as a remote worker (work from home) with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24 MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
To Test your internet download and upload speed: Go to Google. Search for Internet Speed Test or click here. Up to 20% Travel Video cameras must be used during all interviews, as well as during the initial week of orientation if hired. #LI-NB1 #LI-REMOTE The pay range for this position is $82,700.00 - $118,100.00 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 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.
Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), interactionual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
We celebrate diversity and are dedicated to creating an inclusive environment for all employees. For more details: jobs-search. org/marketing_tennessee-r782084/manager-clinical-review-work-from-home-united-states_i1978412617
Work from Home Jobs refer to employment opportunities that allow individuals to perform their professional duties from the comfort of their own homes, leveraging the internet, communication tools, and digital resources. These jobs offer flexibility in working hours, the convenience of avoiding daily commutes, and the potential for a better work-life balance. They can range from freelance gigs to full-time positions in various fields such as tech, customer service, education, and many more. The primary characteristic of these jobs is the location independence they provide, enabling workers to collaborate and contribute regardless of their geographical location.
Work from home jobs, also known as remote jobs, allow employees to perform their duties outside of a traditional office environment, usually from their homes. These jobs are characterized by their flexibility in terms of location and often, work hours, enabling a better balance between work and personal life. They typically require a reliable internet connection and may be facilitated by digital tools like video conferencing and online collaboration platforms. While offering increased autonomy, they can also pose challenges in terms of self-discipline and effective communication.
Work from home jobs, also known as remote jobs or telecommuting positions, allow employees to complete their professional tasks from a location outside the traditional office environment, often their own homes. These roles offer flexibility in terms of hours and location, and they can lead to a better work-life balance. They typically require a reliable internet connection, a functional workspace, and self-discipline. Remote work has grown in popularity due to advancements in technology and increased valuing of flexibility by both employers and employees, particularly in the aftermath of the COVID-19 pandemic.
Work from Home Jobs, often abbreviated as WFH, refer to employment opportunities that allow individuals to perform their job duties from their home environment rather than in a traditional office setting. These jobs are characterized by flexible hours, location independence, and the elimination of daily commutes. Workers in WFH positions often rely on digital tools like video conferencing, online collaborative platforms, and remote access software to engage with colleagues and complete tasks. While increasing work-life balance, these roles demand self-discipline and efficient time management.
