Prior Authorization Operations Associate - Hybrid; Warwick, RI

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Date:
Oct 19, 2026

Location:

Warwick, RI, US,

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.

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.

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.

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.

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

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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 ’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…