Remote Behavioral Health Utilization Review Specialist

Gainwell Technologies LLC; Madison (WI); Remote; USD 91,000 - 130,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies LLC is seeking a detailed clinical reviewer to adjudicate Behavioral Health prior authorizations. You will assess medical necessity and eligibility per state guidelines, focusing on substance use, child and adolescent day treatment, and adult mental health services.

Role emphasizes utilization review and QA with no direct patient contact, offering 100% remote work, full-time hours, and opportunities for career growth within a supportive, learning-oriented environment.

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 WI (or eligible to obtain WI license).
• CSAC or SAC license in WI (CSAC preferred).
• Knowledge of Wisconsin Medicaid or other Medicaid programs.
• Experience in Utilization Management-Review preferred.
• Excellent computer skills and interpersonal communication.

Responsibilities

• Review and evaluate prior authorization submissions utilizing multiple computer systems.
• Enter prior authorization outcomes into MMIS.
• Participate in monthly meetings with leadership and State of Wisconsin stakeholders.
• Provide assistance and education to the provider community.
• Offer analysis and recommendations on methods and process improvements related to the administration and application of medical programs that you support.
• Review communications to providers and members on new/revised policies.

Skills

Excellent communication skills

Strong analytical abilities

Detail-oriented

Team collaboration

Education

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

Tools

MMIS systems

Electronic health records

Job description

Gainwell Technologies LLC is seeking a detailed clinical reviewer to adjudicate Behavioral Health prior authorizations. You will assess medical necessity and eligibility per state guidelines, focusing on substance use, child and adolescent day treatment, and adult mental health services.

Role emphasizes utilization review and QA with no direct patient contact, offering 100% remote work, full-time hours, and opportunities for career growth within a supportive, learning-oriented environment.