Senior Medical Review Manager - Remote - West Sacramento, CA

Gainwell Technologies LLC•West Sacramento, CA

6d•$115,900 - $165,600•Remote

About The Position

The Senior Medical Review Manager is a senior healthcare operations leader responsible for overseeing multidisciplinary teams of physicians, nurses, and clinical review professionals. The role ensures high-quality medical necessity reviews, utilization management, clinical quality, and regulatory compliance while driving operational efficiency, workforce planning, budget management, and continuous process improvement. The manager ensures performance meets contractual and accreditation standards and supports strong provider and client relationships. The role is remote for residents of California, with semi-occasional in-office requirements. Video cameras must be used during interviews and the initial week of orientation.

Requirements

Five or more years of support services, project, or program experience.
Five or more years of leadership or supervisory experience.
Experience working with the technology industry.
Experience working with company products and operating systems.
Experience working with proposals.
Must reside in the State of California.

Responsibilities

Provide strategic leadership and oversight for teams responsible for medical necessity determinations, utilization management, and clinical quality reviews.
Ensure compliance with regulatory, accreditation, contractual, and organizational requirements governing medical review operations.
Identify and implement process improvements to enhance review quality, consistency, efficiency, and turnaround times.
Collaborate with medical directors, physician reviewers, nursing leadership, and operations teams to forecast workload and allocate staffing and resources.
Monitor review volumes, productivity, quality metrics, and service-level performance, and implement corrective actions as needed.
Partner with executive leadership and clinical stakeholders on strategic initiatives to improve medical review outcomes and provider satisfaction.
Develop and manage operating, staffing, and departmental budgets, ensuring efficient resource use and achievement of performance expectations.
Oversee workforce planning, including recruitment, retention, succession planning, and professional development.
Manage relationships with clients, providers, and internal stakeholders to support service delivery and client satisfaction.
Ensure timely and accurate medical review services that meet contractual obligations, accreditation standards, and organizational expectations.
Collaborate with clinical and operational leaders to implement programs, technologies, clinical guidelines, and service offerings.
Participate in business development, including proposal development, operational planning, and presentations to prospective clients.
Recruit, select, and retain qualified physicians, nurses, pharmacists, and other clinical professionals.
Lead, coach, mentor, and manage performance of clinical leadership staff and review teams, fostering accountability, collaboration, and continuous improvement.
Evaluate employee performance and review quality, address performance concerns, and recommend personnel actions in accordance with company policies and professional standards.