Prior Authorization Behavioral Treatment Consultant- Wisconsin

Gainwell Technologies; United States; Remote; USD 91,000 - 130,000; Full time

Benefits offered by this job

Generous vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies seeks a Behavioral Treatment Services Prior Authorization Reviewer to assess Medicaid prior authorization requests for behavioral treatment services. This fully remote role requires evaluating medical necessity and eligibility per state guidelines, coordinating with providers, and acting as a clinical SME for internal and external stakeholders.

The ideal candidate will have 5+ years in Behavioral Treatment, a BCBA license (WI or eligible for WI licensure), and strong

Qualifications

• Minimum of 5 years of Behavioral Treatment experience.
• BCBA license in Wisconsin or eligible for Wisconsin licensure.
• Excellent interpersonal, verbal, and written communication.
• Experience with Medicaid programs and cross-functional collaboration.

Responsibilities

• Ensure Medicaid members receive timely access to behavioral treatment services through accurate reviews.
• Apply clinical expertise to evaluate medical necessity and eligibility per state policies.
• Review prior authorization submissions and request info from providers as needed.
• Enter determinations into MMIS for processing.
• Provide education and guidance to providers on prior authorization requirements.
• Review provider and member communications regarding policies.
• Serve as a clinical SME for providers, internal teams, and stakeholders.
• Support efficient, accurate, and compliant authorization processes.

Skills

Communication

Organizational skills

Policy interpretation

Collaboration

Medicaid knowledge

Behavioral treatment

Education

BCBA license

Job description

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

Join our team as a Behavioral Treatment Services Prior Authorization Reviewer, where you will leverage your clinical expertise to review and adjudicate Medicaid prior authorization requests for behavioral treatment services. In this fully remote role, you will evaluate requests for medical necessity and eligibility in accordance with state policy guidelines, collaborate with providers, and serve as a clinical subject matter expert supporting both internal and external stakeholders. This position offers the opportunity to make a meaningful impact on members' access to care while working alongside a highly skilled and supportive team.

Your role in our mission

• Ensure Medicaid members receive timely access to appropriate behavioral treatment services through accurate and consistent prior authorization reviews.
• Apply clinical expertise to evaluate medical necessity and eligibility in accordance with state Medicaid policies and guidelines.
• Review and evaluate prior authorization submissions and obtain additional information or clarification from providers when necessary.
• Enter prior authorization determinations into the Medicaid Management Information System (MMIS) for processing.
• Provide education, guidance, and support to providers regarding prior authorization requirements and submissions.
• Review provider and member communications related to new or revised policies.
• Serve as a trusted clinical subject matter expert for providers, internal teams, and external stakeholders.
• Contribute to operational excellence by supporting efficient, accurate, and compliant authorization processes.

What we're looking for

• Minimum of 5 years of Behavioral Treatment experience.
• Current BCBA license in the state of Wisconsin, or licensure in another state with the ability to obtain Wisconsin licensure prior to the start date.
• Excellent interpersonal, verbal, and written communication skills.
• Ability to effectively interpret and communicate policies and procedures.
• Strong organizational skills with the ability to manage competing priorities and meet deadlines with minimal supervision.
• Experience collaborating with cross-functional teams and stakeholders to achieve shared goals.
• Knowledge of and/or experience working with the Wisconsin Medicaid program or other state Medicaid programs.

What you should expect in this role

• Fully remote work environment.
• Fast-paced environment requiring strong critical thinking, organization, and attention to detail.
• Weekend hours may be flexible; however, candidates must be available to work weekends as needed to support operational requirements.

Applications will be accepted through October 9, 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.

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 Technologiesis 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.