Utilization Management Medical Director – Remote in US-Gainwell Technologies

Job Description

Job Title: Utilization Management Medical Director – Remote in US

Company: Gainwell Technologies

Location: Ohio

Pay: $100000 – 150000 per year

AI Pay Analysis: The hourly rate corresponding to an annual salary of $100,000 to $150,000 translates to roughly $48 to $72 per hour, which is generally competitive for a Utilization Management Medical Director position, especially in Ohio. This role typically requires extensive experience, often including a medical degree and board certification, along with background in utilization management and healthcare administration. Salaries for similar positions can vary widely, with factors such as the organization’s size, the complexity of the role, and the applicant’s qualifications playing a significant role. However, based on industry standards, this compensation range falls within the reasonable spectrum, making it an appealing offer for candidates with the requisite expertise.

Job description:
It requires exceptional medical expertise to develop impactful solutions that address some of the most intricate challenges in healthcare. We invite you to join us at Gainwell and leverage your skills in innovative ways. We recognize that you have cultivated your career in a dynamic medical landscape. While Gainwell operates with a sense of urgency, we offer the flexibility to work hours that suit your lifestyle, all while ensuring rewarding career opportunities. You will have the chance to advance your career within a company that prioritizes work-life balance, continuous learning, and professional development.

Gainwell Technologies is currently seeking a Kentucky Utilization Review Medical Director. This pivotal role is essential to maintaining the integrity of our payment integrity program. The individual in this position will oversee the audit process, conduct reviews, and engage with the state on a quarterly basis.

Your contributions to our mission will involve:
– Reviewing claims selected for prior authorization for Durable Medical Equipment (DME), Long-Term Acute Care (LTAC), and Skilled Nursing Facility (SNF) services.
– Conducting post-payment reviews utilizing InterQual guidelines.
– Communicating and collaborating with state representatives on quarterly reports.
– Ensuring quality control for the state’s Utilization Review program.
– Engaging with physician reviewers regarding program-related issues.
– Analyzing and presenting billing trends and findings to team members and the California Department of Health Care Services (DHCS).

We are looking for candidates who possess:
– A minimum of five (5) years of experience in utilization review, coupled with an active Kentucky medical license (MD or DO) in good standing, free from suspensions or sanctions.
– At least five (5) years of experience in managed care.
– Proficiency in report creation, querying, and analysis.
– Strong writing skills with the ability to present data in a clear and actionable format.
– Demonstrated expertise in applying InterQual guidelines.
– Remote working capabilities, with daily access to a server, while being situated in the U.S.

In this role, you can expect:
– A full-time permanent salaried position (W-2).
– A work schedule from Monday to Friday, encompassing 30-40 hours per week.
– Occasional quarterly travel to local offices for state meetings.
– Opportunities for upward mobility and career advancement.
– Immediate access to health benefits (medical, dental, and vision) upon employment commencement.
– A 401K company match and other benefits available shortly after your start date.
– A work computer provided by the company.
– For hybrid and remote positions, employees must have a Broadband Internet connection with a minimum download speed of 24 Mbps and upload speed of 8 Mbps, with higher speeds recommended for optimal performance.

To assess your internet capabilities:
– Visit Google.
– Search for “Internet Speed Test.”
– Please note that video conferencing will be required during all interviews and during the initial week of orientation for hired candidates.

This position is part of our ongoing recruitment efforts, and we welcome applications at any time.

The salary range for this role is between $100,000 and $150,000 per year. However, the final base pay offered may vary based on geographic location, internal equity, job-related knowledge, skills, and overall experience, among other considerations. Join Gainwell and put your passion to work as you develop your career in a company that values flexibility, learning, and professional growth. All full-time, salaried candidates are eligible for our generous flexible vacation policy and educational assistance. Additionally, we provide a variety of leadership and technical development academies to enhance your skills and capabilities.

We believe in the power of collaboration to create meaningful change in healthcare. By uniting individuals who are dedicated to improving healthcare for all, we can achieve the extraordinary. Build your career with Gainwell, a leader in the industry, and be part of a company where collaboration, innovation, and inclusion drive our success. For more information about Gainwell and to explore available job openings, please visit our careers page.

Gainwell Technologies is committed to fostering a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, ensuring that all qualified applicants receive fair consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or any other legally protected characteristics. We celebrate diversity and are dedicated to cultivating an inclusive environment for all employees.

Job Posting Date: Fri, 21 Feb 2025 00:03:01 GMT

Apply now!