Senior Medical Review Manager

About the role

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Responsibilities

• Provides 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.
• Ensures compliance with applicable regulatory, accreditation, contractual, and organizational requirements governing medical review operations.
• Identifies, develops, and implements process improvements to enhance clinical review quality, consistency, efficiency, and turnaround time performance.
• Collaborates with medical directors, physician reviewers, nursing leadership, and operational teams to forecast workload demand and ensure adequate staffing and resource allocation.
• Monitors clinical review volume, productivity, quality metrics, and service-level performance, implementing corrective actions when required.
• Partners with executive leadership and clinical stakeholders to develop strategic initiatives that improve medical review outcomes and provider satisfaction.
• Develops, manages, and oversees operating, staffing, and departmental budgets, ensuring efficient utilization of resources while meeting performance expectations.
• Oversees workforce planning, including recruitment, retention, succession planning, and professional development for physicians, nurses, and clinical review staff.
• Manages complex relationships with clients, providers, and internal stakeholders to ensure exceptional service delivery and client satisfaction.
• Ensures timely and accurate delivery of medical review services that meet contractual obligations, accreditation standards, and organizational performance expectations.
• Collaborates with clinical and operational leaders to implement new programs, technologies, clinical guidelines, and service offerings that enhance medical review operations.
• Participates in business development activities, including proposal development, operational planning, and presentation of clinical review capabilities to prospective clients.
• Recruits, selects, and retains highly qualified clinical professionals, including physicians, nurses, and pharmacists.
• Provides leadership, coaching, mentoring, and performance management to clinical leadership staff and review teams, fostering a culture of accountability, collaboration, and continuous improvement.
• Evaluates employee performance and clinical review quality, addresses performance concerns, and recommends personnel actions in accordance with company policies and professional standards.

Requirements

• 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

Benefits

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