Utilization Management Medical Director - Remote in US

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work 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

Gainwell Technologies is seeking a Kentucky Utilization Review Medical Director. This role helps maintain the integrity of the payment integrity program. The person in this position will play a vital role in supervising the audit process, performing reviews, and interacting with the state quarterly.

Your role in our mission

• Reviews claims selected for prior authorization for DME, LTAC, an SNF
• Review claims for post payment review using InterQual
• Communicates with the state on quarterly reports
• Provide Quality control for the state’s Utilization Review program.
• Communicate with physician reviewers regarding program issues
• Communicate and present billing trends and findings to team members and DHCS

What we're looking for

• A minimum of five (5) years of experience in utilization review. Must hold an active KY license (MD or DO), in good-standing and free of any suspensions or sanctions from Federal, State, or local jurisdictions
• Five (5) years of experience in managed care

• Proficiency in creating, querying, and analyzing reports
• Strong writing skills with the ability to convey data in a clear and actionable manner
• Demonstrated expertise and knowledge apply InterQual guidelines
• Position is remote requiring daily access to server, location in US

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
  • Monday through Friday work schedule (30-40 hours per week).
  • There may be quarterly travel into local office for meeting with State.
• Upward career advancement is possible and encouraged.
• Health (medical, dental, vision) and paid time off benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Computer for work company provided.
• For all hybrid and remote positions employees' Broadband Internet connections, should have a minimum speed of 24MBS 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.  
• Video cameras must be used during all interviews, as well as during the initial week of orientation if hired.

This position is intended for pipelining. We will accept applications on an ongoing basis.

The pay range for this position is $100,000 - $150,000 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), sexual 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.