[Hiring] Utilization Review Specialist- Clinical Reviewer @Gainwell Technologies LLC
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Role Description
As a Utilization Review Specialist- Clinical Reviewer at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.
• Provide clinical expertise to staff, management, and customers with minimal direction
• Act as a liaison between customers, providers, and recipients to resolve issues and clarify healthcare matters
• Recommend and promote program improvements to enhance access to quality care and manage benefit packages
• Assist in adjudicating medically complex prior authorizations
• Participate in customer policy development
• Support drafting and revising provider manuals, bulletins, and related publications
• Collaborate with healthcare groups and associations on state medical program issues
• Serve as part of the Prior Authorization team reviewing and pre-approving selected non-emergency services
• Support cost containment and utilization review to ensure services are medically necessary, appropriate, and cost-effective
• Perform additional related duties as assigned
Qualifications
• Bachelor’s degree or equivalent work experience or combination of education and experience
• Minimum of two years Medicaid experience or other health care experience preferred
• Active license as RN or LPN in the United States
Requirements
• Ability to make prior authorization determination
• Strong oral/written communication skills
• Ability to read, understand, and interpret complex regulatory and procedural documents
• PC skills
• Demonstrates strong writing skills
• Time management and organizational skills
• Ability to work independently without frequent supervision
• Strong analytical skills
• Ability to successfully interact with other departments
Benefits
• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Variety of leadership and technical development academies to help build your skills and capabilities
Company Description
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.
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Role Description
As a Utilization Review Specialist- Clinical Reviewer at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges.
• Provide clinical expertise to staff, management, and customers with minimal direction
• Act as a liaison between customers, providers, and recipients to resolve issues and clarify healthcare matters
• Recommend and promote program improvements to enhance access to quality care and manage benefit packages
• Assist in adjudicating medically complex prior authorizations
• Participate in customer policy development
• Support drafting and revising provider manuals, bulletins, and related publications
• Collaborate with healthcare groups and associations on state medical program issues
• Serve as part of the Prior Authorization team reviewing and pre-approving selected non-emergency services
• Support cost containment and utilization review to ensure services are medically necessary, appropriate, and cost-effective
• Perform additional related duties as assigned
Qualifications
• Bachelor’s degree or equivalent work experience or combination of education and experience
• Minimum of two years Medicaid experience or other health care experience preferred
• Active license as RN or LPN in the United States
Requirements
• Ability to make prior authorization determination
• Strong oral/written communication skills
• Ability to read, understand, and interpret complex regulatory and procedural documents
• PC skills
• Demonstrates strong writing skills
• Time management and organizational skills
• Ability to work independently without frequent supervision
• Strong analytical skills
• Ability to successfully interact with other departments
Benefits
• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Variety of leadership and technical development academies to help build your skills and capabilities
Company Description
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.
Apply tot his job
Apply To this Job