
Prior Authorization Manager
Required skills
- Prior Authorization
- Utilization Review
- Medicaid
- Quality Assurance
- Microsoft Office Suite
Nice to have
- Back Office Operations Software
Role summary
Gainwell is seeking a Prior Authorization Manager to lead teams in delivering superior service and achieving account goals within the healthcare sector. This role involves managing staff performance, optimizing processes, and ensuring high-quality standards. The manager will build and develop teams, establish routines, utilize reporting tools for performance, and provide coaching. Key responsibilities include cultivating relationships with business partners, improving operational delivery, achieving SLAs, driving accountability through SOPs, removing obstacles, and managing risks. The position requires 7+ years of people management experience in healthcare, QA experience for utilization decisions, and proficiency with Microsoft Office. Two years of Medicaid Prior Authorization/Utilization Review experience and back-office operations software experience are preferred. This is a remote, full-time position with a salary range of $75,700 - $108,100 per year.
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
As a Manager at Gainwell, you will be part of an innovative product company with a mission to serve the healthcare needs of our communities. You will oversee and guide your team to deliver superior service and achieve account goals and outcomes. You manage the performance and engagement of your staff, optimize processes, and maintain the highest quality standards.
Your role in our mission
Gainwell empowers you through innovative technologies and solutions to deliver better health and human services outcomes. When joining Gainwell, you will:
- Build, develop, and lead teams of leaders and individual contributors, supporting employees and executing day-to-day operations delivery for an account(s).
- Establish and effectively lead routines regularly and utilize tools and reporting to drive team performance; train and provide ongoing coaching to ensure employee engagement while maintaining client satisfaction.
- Effectively cultivate relationships with account leaders and business partners to proactively identify and enact opportunities to improve the delivery of operational products, services, and capabilities.
- Work with employees and operational leaders to achieve Client Service Level Agreements (SLAs) and drive accountability and efficiency by adopting standard operating procedures.
- Create conditions for success by removing obstacles and championing change to drive employee awareness and a connection to their work and contributions.
- Identify and manage existing and emerging risks from business activities and implement mitigation strategies to improve performance.
What we're looking for
- 7 or more years of people management experience in healthcare.
- Experience in quality assurance to support accurate utilization decisions based upon nationally recognized guidelines
- Minimum of two years’ Medicaid experience in Prior Authorization/Utilization Review preferred.
- Proficient with Microsoft Office suite required and experience with software applications to manage and back-office operations preferred.
- Strong written and oral communication and interpersonal skills to work effectively with team members, customers, and clients.
- Demonstrated strategic initiative implementation and execution, specifically with operating policies and procedures and work process improvements in operations.
What you should expect in this role
- Remote
This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.
#LI-LM1
#LI-REMOTE
The pay range for this position is $75,700 - $108,100 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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
Similar roles
Call Center Specialist- Anchorage, AK (Hybrid)Gainwell Technologies · Anchorage, AK · Hybrid
SUR Developer IGainwell Technologies · Remote · Remote- Prior Authorization Specialist I (On-Site)Community Health Center of Southeast Kansas · Pittsburg, KS · Onsite
Sr. Director, Pharmacy - Prior Authorization & Call CenterBlue Shield of California · Oakland, CA · Hybrid- Prior Authorization Pharmacy Technician - Rhode Island Pharmacy LicenseShields Health Solutions · Remote · Remote
Pharmacy Prior Authorization SpecialistOnco360 Oncology Pharmacy · New Hyde Park, NY · Hybrid
