Behavioral Health Utilization Review Specialist

Gainwell Technologies LLC; Seattle (WA); A distancia; USD 91.000 - 130.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Generous, flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and technical development

Descripción de la vacante

Gainwell Technologies LLC is seeking a licensed behavioral health professional to review prior authorization submissions and perform MMIS data entry for Medicaid processing. The role involves collaboration with leadership and Wisconsin stakeholders to ensure efficient program administration.

The position requires a Master’s degree in counseling or related field and WI licensure, with CSAC/SAC preferred. It is a 100% remote, full‑time role offering competitive benefits and ongoing professional

Formación

• Master's degree in counseling, social work, marriage and family therapy or equivalent.
• Current LPC, LCSW, or LMFT license in the state of WI (or license from another state with ability to obtain WI license before start date).
• CSAC or SAC license in the state of WI (CSAC preferred).
• Knowledge of Wisconsin Medicaid program (or other state Medicaid programs) desired.
• Previous experience in Utilization Management-Review preferred.
• Excellent computer skills.

Responsabilidades

• Review and evaluate prior authorization submissions utilizing multiple computer systems, and when appropriate seek additional information or clarification from requesting providers.
• Enter prior authorization outcomes into the Medicaid Management Information System (MMIS) for processing.
• Participate in monthly meetings which leadership, operational staff support, clinical peers and State of Wisconsin stakeholders.
• Provide assistance and education to the provider community related to specific prior authorization submissions, when applicable.
• Offer analysis and recommendations on methods and potential process improvements related to the administration and application of medical programs that you support.
• Review communications to providers and members on new/revised policies.

Conocimientos

Excellent computer skills

Interpersonal communication

Time management

Team collaboration

Policy interpretation

Educación

Master's degree in counseling, social work, marriage and family therapy or equivalent

Descripción del empleo

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

• Review and evaluate prior authorization submissions utilizing multiple computer systems, and when appropriate seek additional information or clarification from requesting providers.
• Enter prior authorization outcomes into the Medicaid Management Information System (MMIS) for processing.
• Participate in monthly meetings which leadership, operational staff support, clinical peers and State of Wisconsin stakeholders.
• Provide assistance and education to the provider community related to specific prior authorization submissions, when applicable.
• Offer analysis and recommendations on methods and potential process improvements related to the administration and application of medical programs that you support.
• Review communications to providers and members on new/revised policies.

What we're looking for

• Master's degree in counseling, social work, marriage and family therapy or equivalent
• A minimum of 5 years clinical work experience
• Current LPC, LCSW, or LMFT license in the state of WI (or license from another state and ability to obtain WI license prior to position start date)
• CSAC or SAC license in the state of WI (CSAC preferred)
• Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs) desired
• Previous experience in Utilization Management-Review preferred
• Excellent computer skills
• Excellent interpersonal, oral, and written communication skills.
• Ability to meet deadlines and manage priorities with minimal direct supervision
• Experience working with various partners or team members toward shared goals
• Ability to communicate effectively and interpret policies and procedures

What you should expect in this role

• 100% Remote home office.
• Full-time position.

Applications will be accepted through November 2, 2026.

The pay range for this position is $90,900.00 - $129,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

• generous, flexible vacation policy
• a 401(k) employer match
• comprehensive health benefits
• educational assistance
• leadership and technical development academies to help build your skills and capabilities

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.

Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth.

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.