Remote Behavioral Health Prior Authorization Reviewer

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

Benefits offered by this job

Flexible vacation policy

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies seeks a Behavioral Treatment Services Prior Authorization Reviewer to review Medicaid prior authorization requests for behavioral treatment services in a fully remote role. You will evaluate medical necessity and eligibility per state guidelines and collaborate with providers, supporting internal and external stakeholders.

This position offers growth in a fast-paced healthcare environment with flexible hours and a commitment to work-life balance, learning, and career

Qualifications

• Minimum of 5 years of Behavioral Treatment experience.
• Current BCBA license in WI, or willing to obtain Wisconsin licensure before start date.
• Excellent interpersonal, verbal, and written communication skills.

Responsibilities

• Review and adjudicate Medicaid prior authorization requests for behavioral treatment services.
• Evaluate medical necessity and eligibility per state policies and guidelines.
• Review prior authorization submissions and request additional information from providers as needed.
• Enter determinations into MMIS for processing.
• Provide education and guidance to providers regarding authorization requirements.
• Review provider and member communications related to new or revised policies.
• Serve as clinical subject matter expert for providers, internal teams, and external stakeholders.
• Support efficient, accurate, and compliant authorization processes.

Skills

Interpersonal skills

Verbal communication

Written communication

Organizational skills

Policy interpretation

Time management

Collaboration

Education

BCBA license

Job description

Gainwell Technologies seeks a Behavioral Treatment Services Prior Authorization Reviewer to review Medicaid prior authorization requests for behavioral treatment services in a fully remote role. You will evaluate medical necessity and eligibility per state guidelines and collaborate with providers, supporting internal and external stakeholders.

This position offers growth in a fast-paced healthcare environment with flexible hours and a commitment to work-life balance, learning, and career