Qureos Mentor

Gainwell Technologies

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 We are seeking a talented individual for a Nurse Reviewer- Itemized Bill Review role to perform reviews of medical records, healthcare claims, itemized medical bills, and UB‑04 forms to ensure accuracy, compliance, and proper billing practices. This position requires clinical review expertise as well as experience with itemized bill review.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Review medical claims using the UB‑04 and detailed itemized statements to validate line‑item charges.
 </li>
 <li>
 Verify accuracy of itemized charges in accordance with client policy and industry standards.
 </li>
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 Perform level‑of‑care and utilization reviews by analyzing medical records and comparing them against criteria to determine appropriateness and reasonableness of care.
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 Apply critical thinking and decision‑making skills to determine whether medical record documentation supports the need for services while meeting production goals and quality standards.
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 Assist management with training new reviewers, including daily monitoring, mentoring, feedback, and education.
 </li>
 <li>
 Maintain current knowledge of clinical criteria guidelines and/or coding guidelines; complete required CEUs to maintain RN licensure.
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 Attend training and scheduled meetings to enhance knowledge of clinical policies, procedures, rules, and regulations.
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 Actively cross‑train to perform reviews of multiple claim types to support a flexible workforce that meets client needs.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active, unrestricted RN license in the United States and in the primary state of residence; active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) required.
 </li>
 <li>
 5+ years of clinical experience in an inpatient hospital setting required.
 </li>
 <li>
 1+ year of itemized bill review experience required.
 </li>
 <li>
 3+ years of utilization review or claims auditing experience preferred.
 </li>
 <li>
 Experience with CPT, ICD‑10, and HCPCS coding guidelines.
 </li>
 <li>
 Experience using MCG or InterQual criteria preferred.
 </li>
 <li>
 Ability to multitask in a fast‑paced production environment.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 This is a home‑based position, and you must have a work location within the continental United States.
 </li>
 <li>
 You must provide a high‑speed internet connection and maintain a work environment free from distractions.
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 Ability to work during normal business hours, as this role requires frequent interaction with the team and other departments.
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 May be required to work extended hours for special business needs.
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 May be required to travel at least 10% of the time based on business needs.
 
 
 </li>
 </ul>
 This position is for pipeline purposes, and we welcome applications on an ongoing basis.
 
 
 The pay range for this position is $78,000.00 - $85,000.00 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&rsquo;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&rsquo;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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Nurse Reviewer - Itemized Bill Review

<div>
 Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
 
 
 
 Summary
 
 
 
 We&rsquo;re seeking a motivated and energetic individual to join our team in Baton Rouge, LA as a Provider Services Call Center Agent. In this role, you will assist healthcare professionals with billing requirements, policy questions, and other Medicaid-related inquiries. You'll be expected to research complex issues, maintain up-to-date knowledge of policies, and log all interactions accurately.
 
 
 This position requires excellent oral and written communication skills, strong customer service abilities, professional telephone etiquette, and a positive, patient attitude. Candidates should be self-starters who can multitask and solve problems effectively in a fast-paced environment. Proficiency in Microsoft Office and the ability to navigate multiple computer systems is essential.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Handle a high volume of inbound calls and provide accurate assistance to healthcare providers.
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 Meet and maintain performance standards, including resolving 92% of provider calls within 3&ndash;5 minutes, as required by contract.
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 Communicate professionally and efficiently with providers to resolve issues.
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 Accurately log and track all call interactions in the designated call tracking system.
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 Support team objectives and collaborate with coworkers to meet departmental goals.
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 Demonstrate strong multitasking and information retention abilities in a high-paced environment.
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 Maintain effective and professional relationships with clients, coworkers, providers, and members.
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 Adhere to scheduled work hours and maintain consistent attendance.
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 <li>
 Uphold HIPAA compliance and ensure confidentiality of sensitive information.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 High School Diploma or equivalent (GED)
 </li>
 <li>
 1&ndash;2 years of experience in customer service or a call center environment; healthcare experience preferred
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 <li>
 Basic proficiency with Microsoft Office applications (Outlook, Word, Excel)
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 <li>
 Experience working with Medicaid programs preferred
 </li>
 <li>
 Familiarity with medical claims processing or review preferred
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Schedule: This is primarily a remote position; however, candidates must reside within driving distance of our Baton Rouge office (8591 United Plaza Blvd, Suite 270, Baton Rouge, LA 70809). . The standard work hours are Monday through Friday, 8:00 AM to 5:00 PM CST.
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 Training: A comprehensive training program will be provided prior to onboarding. Training typically lasts 6 to 8 weeks.
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 Assessment Requirement: Candidates will be required to complete a skills and competency assessment before advancing to the next stage of the selection process.
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 Video Interview Requirement: Candidates must use a webcam for all interviews and during the first week of orientation.
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 Internet Requirements (for remote work):
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 A broadband internet connection with a minimum speed of 24 Mbps download and 8 Mbps upload is required.
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 Higher speeds are recommended to ensure optimal performance.
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 To test your internet speed, go to Google and search: &ldquo;Internet Speed Test.&rdquo;
 
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 </ul>
 </ul>
 &ldquo;This posting is intended for pipelining. We will accept applications on an ongoing basis.&rdquo;
 
 
 The pay range for this position is $29,100.00 - $41,600.00 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&rsquo;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&rsquo;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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
 
</div>

Call Center Representative - Baton Rouge, LA - Remote

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines. This involves reviewing medical documentation, accurately documenting findings, and ensuring policy compliance.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting quality and production goals.
 </li>
 <li>
 Use clinical criteria for decision-making, referring complex cases to Medical Directors when needed.
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 Engage with providers to gather clinical information, apply guidelines, and make determinations.
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 Document findings and rationale in medical management systems.
 </li>
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 Assist in training new nurses, provide feedback, and stay updated on clinical guidelines.
 </li>
 <li>
 Maintain RN license and meet continuing education requirements.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active, unrestricted RN licensure in the U.S. and primary state of residence, plus an active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC); verification required during post-offer background check.
 </li>
 <li>
 3+ years of inpatient clinical experience.
 </li>
 <li>
 1+ year in prior authorization reviews using InterQual or MCG.
 </li>
 <li>
 Strong written communication skills in a fast-paced setting.
 </li>
 <li>
 Proficient in Microsoft Office and other computer applications.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Home-based role available to applicants residing anywhere in the U.S.
 </li>
 <li>
 High-speed internet and a distraction-free workspace required.
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 Core hours: 8:00 AM - 6:00 PM ET, with potential for extended hours.
 </li>
 <li>
 Occasional travel (up to 10%) based on business needs.
 
 
 </li>
 </ul>
 This position is for pipeline purposes, and we welcome applications on an ongoing basis.
 
 
 The pay range for this position is $78,000.00 to $88,000.00 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&rsquo;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&rsquo;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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
 
</div>

Utilization Review Nurse- Remote

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
 
 
 
 Summary
 
 
 
 Supports prior authorization (PA) processing with a focus on Drug-Drug Interaction (DDI) review within PBM operations. Helps ensure safe, accurate, and compliant medication approvals while contributing to quality clinical support and operational efficiency.
 
 
 
 Your Role in Our Mission
 
 
 
 <ul>
 <li>
 Process prior authorization requests with an emphasis on DDI screening and clinical accuracy
 </li>
 <li>
 Review medication profiles to identify potential drug-drug interactions and risks
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 <li>
 Collaborate with pharmacists and clinical teams to support reviews, escalations, and approvals
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 <li>
 Maintain accurate and compliant documentation of all reviews and decisions
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 <li>
 Meet established productivity, quality, and service level benchmarks
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 <li>
 Support the implementation of prior authorization processes across multiple programs and accounts
 
 
 </li>
 </ul>
 
 What We&rsquo;re Looking For
 
 
 
 <ul>
 <li>
 High school diploma or equivalent required
 </li>
 <li>
 Pharmacy Technician certification required in accordance with state regulations, where applicable
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 <li>
 2+ years of experience in PBM, pharmacy operations, or prior authorization environments
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 <li>
 Familiarity with DDI screening tools, pharmacy systems, and clinical review processes
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 <li>
 Strong attention to detail with a focus on accuracy, compliance, and quality
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Fully remote (U.S.) work environment
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 <li>
 Clinical-support role within PBM pharmacy operations
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 <li>
 Focus on patient safety, accuracy, and regulatory compliance
 </li>
 <li>
 Ongoing collaboration with pharmacists and clinical teams
 
 
 </li>
 </ul>
 The pay range for this position is $38,400.00 - $54,900.00 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&rsquo;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&rsquo;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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
</div>

Prior Authorization Pharmacy Technician - Remote US

<div>
 It takes great medical minds to create powerful solutions that solve some of healthcare&rsquo;s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you&rsquo;ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you&rsquo;ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You&rsquo;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 Certified Pharmacy Technician - Remote US to support a high-volume PBM clinical and technical call center environment. In this fully remote role, you will assist with provider inquiries, process prior authorizations, and help ensure timely, accurate resolution of pharmacy-related requests while maintaining compliance with HIPAA, state regulations, and internal quality standards.
 
 
 
 Your role in our mission
 
 
 
 <ul>
 <li>
 Process prior authorization requests within required turnaround times and complete approvals when pharmacist review is not needed.
 </li>
 <li>
 Handle provider inquiries efficiently across phone, email, fax, and web-based channels, aiming for first-contact resolution whenever possible.
 </li>
 <li>
 Conduct outbound communication to providers to obtain missing information and support closure of pending prior authorization cases.
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 <li>
 Accurately document all interactions, decisions, and follow-up actions in the appropriate systems.
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 <li>
 Follow established workflows, productivity expectations, and quality standards while identifying opportunities for process improvement.
 
 
 </li>
 </ul>
 
 What We're Looking For
 
 
 
 <ul>
 <li>
 Active Certified Pharmacy Technician (CPhT) certification and/or active Pharmacy Technician registration as required by applicable Board of Pharmacy regulations.
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 <li>
 At least 2 years of pharmacy technician experience, preferably in retail, hospital, managed care, PBM, insurance, or prior authorization support.
 </li>
 <li>
 Strong knowledge of drug terminology, pharmacy operations, and pharmacy benefit or claims-related processes.
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 <li>
 Experience working in a fast-paced, metrics-driven environment with strong attention to detail and accuracy.
 </li>
 <li>
 Proficiency in Microsoft Office applications and the ability to quickly learn internal systems and workflows.
 
 
 </li>
 </ul>
 
 What You Should Expect In This Role
 
 
 
 <ul>
 <li>
 Fully remote position supporting a high-volume call center operation.
 </li>
 <li>
 Frequent interaction with providers through phone, email, fax, and web portals.
 </li>
 <li>
 Strict adherence to HIPAA, PHI, regulatory, and turnaround-time requirements.
 </li>
 <li>
 Performance expectations tied to productivity, quality, and service metrics.
 </li>
 <li>
 Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, floating holidays, and wellness programs.
 
 
 </li>
 </ul>
 The pay range for this position is $33,500.00 - $47,900.00 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&rsquo;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&rsquo;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 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), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines &ldquo;wages&rdquo; and &ldquo;wage rates&rdquo; to include &ldquo;all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
 
 
 
</div>

Certified Pharmacy Technician - Remote US