Remote Behavioral Health Utilization Review Specialist

Gainwell Technologies LLC; Columbus (OH); Remote; USD 91,000 - 130,000; Full time

Benefits offered by this job

Remote work

Full-time

Generous vacation policy

401(k) match

Health benefits

Educational assistance

Development academies

Job summary

Gainwell Technologies LLC in the United States is seeking a healthcare utilization reviewer to adjudicate Behavioral Health prior authorizations based on medical necessity and eligibility, following state guidelines. The role focuses on Medicaid-related programs with no direct patient contact.

You will review submissions, enter outcomes into MMIS, participate in monthly meetings with stakeholders, and provide provider education. This 100% remote, full-time position offers growth and benefits.

Qualifications

• Master's degree in counseling, social work, marriage and family therapy or equivalent.
• Minimum of 5 years clinical work experience.
• Current LPC, LCSW, or LMFT license in Wisconsin (or ability to obtain WI license).
• CSAC or SAC license in Wisconsin (CSAC preferred).
• Knowledge of Wisconsin Medicaid or other state Medicaid programs.
• Experience in Utilization Management-Review preferred.
• Excellent computer skills and strong communication abilities.

Responsibilities

• Review and evaluate prior authorization submissions using multiple systems and obtain clarification when needed.
• Enter prior authorization outcomes into MMIS for processing.
• Participate in monthly leadership and stakeholder meetings with state partners.
• Provide education to providers regarding specific prior authorizations.
• Suggest process improvements for administration of medical programs.
• Review communications to providers and members on new or revised policies.

Skills

Clinical experience

Utilization management

Prior authorization

Policy interpretation

Excellent communication

Education

Master's degree in counseling/social work

Tools

MMIS

Job description

Gainwell Technologies LLC in the United States is seeking a healthcare utilization reviewer to adjudicate Behavioral Health prior authorizations based on medical necessity and eligibility, following state guidelines. The role focuses on Medicaid-related programs with no direct patient contact.

You will review submissions, enter outcomes into MMIS, participate in monthly meetings with stakeholders, and provide provider education. This 100% remote, full-time position offers growth and benefits.