Job summary
Job post source
This job is directly from Gainwell Technologies
Job overview
The Utilization Review Nurse role at Gainwell Technologies involves conducting medical necessity reviews for prior authorization and other utilization management processes to ensure appropriate healthcare services.
Responsibilities and impact
The nurse will review admissions, procedures, and services for medical necessity, use clinical criteria for decisions, engage with providers for clinical information, document findings, assist in training new nurses, and maintain licensure and education requirements.
Compensation and benefits
The position offers a salary range of $65,000 to $78,000 annually, flexible vacation policy, 401(k) employer match, comprehensive health benefits, educational assistance, and opportunities for leadership and technical development.
Experience and skills
Candidates must have an active RN license, at least 3 years of inpatient clinical experience, 1 year of prior authorization review experience using InterQual or MCG, strong written communication skills, and proficiency in Microsoft Office and other computer applications.
Career development
Gainwell provides career growth opportunities through flexible work arrangements, continuous learning, leadership, and technical development academies.
Work environment and culture
The company values work-life balance, collaboration, innovation, inclusion, and offers a flexible, home-based work environment with core hours and occasional travel.
Company information
Gainwell Technologies is an industry leader focused on healthcare solutions, emphasizing collaboration, innovation, and inclusion, with a commitment to equal opportunity employment.
Job location and travel
This is a remote, home-based position requiring a distraction-free workspace and high-speed internet, with core hours from 8:00 AM to 6:00 PM ET and occasional travel up to 10%.
Unique job features
The role offers the unique opportunity to work remotely with flexible hours, engage in meaningful healthcare utilization review, and participate in ongoing training and development within a leading healthcare technology company.
Company overview
Gainwell Technologies is a leading provider of technology solutions primarily focused on the healthcare sector, offering services such as Medicaid Management Information Systems (MMIS), analytics, and consulting to state and local governments. They generate revenue through long-term contracts with public sector clients, leveraging their expertise to improve healthcare delivery and operational efficiency. Established in 2020 after a divestiture from DXC Technology, Gainwell has rapidly grown by focusing on innovative, client-centric solutions, and maintaining a strong commitment to public health and welfare.
How to land this job
Position your resume to highlight your active RN license, inpatient clinical experience of 3+ years, and at least 1 year of prior authorization review experience using InterQual or MCG, focusing on medical necessity and policy compliance.
Emphasize your strong written communication skills and proficiency with Microsoft Office and medical management systems, showcasing your ability to document findings accurately in a fast-paced healthcare environment.
Apply through multiple channels including Gainwell Technologies' corporate careers site, LinkedIn, and other job boards where this remote position is posted to maximize your visibility.
Connect with current nurses or hiring managers in Gainwell's Utilization Review or Clinical Operations teams on LinkedIn; use ice breakers such as asking about recent updates to clinical guidelines or expressing interest in how Gainwell supports remote nursing roles.
Optimize your resume for ATS by incorporating keywords like 'utilization review,' 'prior authorization,' 'InterQual,' 'MCG,' 'medical necessity,' 'clinical criteria,' and 'RN license' to ensure it passes automated screenings.
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