Prior Authorization Operations Associate - Hybrid (Warwick, RI)

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’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 The Prior Authorization Operations Associate is responsible for, with minimal supervision, processing and maintaining prior authorization requests within the Medicaid Management Information System (MMIS). This role supports the State of Rhode Island Medicaid Program by ensuring authorizations are accurately entered, updated, and maintained in accordance with established coverage guidelines, program rules, and operational policies.

This position is primarily operational and administrative, not clinical in nature. However, the Associate must be able to interpret coverage criteria and authorization requirements to ensure accurate processing and routing of requests.

Your role in our mission

• Process prior authorization requests and updates in MMIS and related systems in accordance with program guidelines and established workflows.
• Review authorization requests for completeness, accuracy, and compliance with coverage rules, authorization policies, and submission requirements.
• Research and resolve authorization discrepancies, processing errors, and system issues while coordinating with internal teams as needed.
• Respond to inquiries from providers, internal stakeholders, and State partners regarding authorization status, requirements, and operational issues.
• Maintain accurate documentation and audit trails, support reporting and reconciliation activities, and ensure compliance with applicable policies, procedures, and regulatory requirements.

What We're Looking For

• Strong attention to detail and accuracy when processing high volumes of transactions.
• Ability to interpret and apply written coverage guidelines, policies, and procedures.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong organizational and time management skills, with the ability to prioritize tasks and meet required turnaround times.
• Effective oral and written communication skills, proficiency in Microsoft Office, and the ability to work independently and collaboratively while maintaining professionalism and accountability.

What You Should Expect In This Role

• Strong attention to detail and accuracy when processing high volumes of transactions.

• Ability to interpret and apply written coverage guidelines, policies, and procedures.

• Excellent analytical, problem-solving, and decision-making skills.

• Strong organizational and time management skills, with the ability to prioritize tasks and meet required turnaround times.

• Effective oral and written communication skills, proficiency in Microsoft Office, and the ability to work independently and collaboratively while maintaining professionalism and accountability.

• Hybrid position with on-site days located in Warwick, RI.

• M-F 8:30am-5PM

"The deadline to submit applications for this posting is 11/15/2026"

The pay range for this position is $35,000.00 - $50,000.00 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’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 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 “wages” and “wage rates” to include “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.