Remote 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

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