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

The Prior Authorization Utilization Review Specialist - PASRR provides clinical expertise to staff, management and customer within a health care account. Act as liaison to customers, providers, and recipients by resolving problems and clarifying medical and healthcare issues. Recommend and promote beneficial changes to customer programs to promote access to quality care and control of benefit packages.

Your role in our mission

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• Assist in adjudication of medically complicated claims.
• Participate in customer’s policy development. Provide assistance in drafting provider manuals, bulletins, and revisions to promote publication.
• Assist with organized healthcare groups and associations on various medical issues related to the State’s medical program.
• This clinician will be part of the Prior Authorization team. The team has the responsibility for the following: to review, assess, and pre-approve selected non-emergency medical services prior to the actual delivery.
• The clinician is to help with cost containment and utilization review measures to make payment for only those treatments and services that are medically necessary, appropriate, and cost effective.
• The clinician provides support to the case management functions by accepting treatment plans as a form of prior authorization.
• Other duties may be assigned as required.
  
  

What we're looking for

• Active nursing license (RN or LPN license) in the United States required with n o license restrictions
• Minimum of two (2) years Medicaid experience or other health care experience preferred
• Knowledge of PASRR process preferred
• Strong oral and written/ communication skills. Ability to manage time and be organized in daily tasks
• Strong analytical skills to make medical necessity determinations based on regulatory and procedural documents
  
  

What you should expect in this role

• This is a full-time permanent regular salaried (W-2) employee position.
• Monday through Friday work schedule (40 hours per week).
• 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 $65,000 - $70,000 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.