Remote Behavioral Health Utilization Review Specialist

Socket.dev; Wisconsin; Remote; USD 91,000 - 130,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Job summary

Gainwell Technologies is hiring to adjudicate Behavioral Health prior authorizations based on medical necessity and state guidelines. The role focuses on utilization review without direct patient contact, supporting areas like Substance Use Disorder and Mental Health services.

You will work remotely, review submissions, and enter outcomes into MMIS. The position requires a Master's in counseling or related field, WI licensure or eligibility, and at least 5 years of clinical experience.

Qualifications

• Master's degree in counseling, social work, marriage and family therapy or equivalent.
• Excellent computer skills and proficiency with healthcare information systems.
• Ability to communicate clearly with providers and state program stakeholders.

Responsibilities

• Review and adjudicate prior authorization submissions based on medical necessity and policy guidelines.
• Enter outcomes into the Medicaid Management Information System (MMIS) for processing.
• Participate in monthly cross-functional meetings with leadership, staff, clinical peers and state stakeholders.
• Provide education to providers about prior authorization submissions when applicable.
• Suggest process improvements for administration of medical programs you support.
• Review communications to providers and members about new or revised policies.

Skills

Interpersonal skills

Oral communication

Written communication

Deadline management

Education

Master's degree in counseling/social work/therapy

Tools

MMIS

Job description

Gainwell Technologies is hiring to adjudicate Behavioral Health prior authorizations based on medical necessity and state guidelines. The role focuses on utilization review without direct patient contact, supporting areas like Substance Use Disorder and Mental Health services.

You will work remotely, review submissions, and enter outcomes into MMIS. The position requires a Master's in counseling or related field, WI licensure or eligibility, and at least 5 years of clinical experience.