Remote Behavioral Health Utilization Review Specialist

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

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Generous vacation policy

Leadership and technical development A

Job summary

Gainwell Technologies is seeking a Behavioral Health prior authorization specialist to adjudicate submissions and ensure medical necessity per state guidelines. Role focuses on utilization review with no direct patient contact, including adult and child services in Medicaid-related programs.

Requirements include a Master’s in a relevant field and 5+ years of clinical experience, with active WI licenses (LPC/LCSW/LMFT or CSAC/SAC).

Qualifications

• Master's degree in counseling, social work, marriage and family therapy or equivalent.
• A minimum of 5 years clinical work experience.
• Current LPC, LCSW, or LMFT license in the state of WI (or license from another state and ability to obtain WI license prior to position start date).
• CSAC or SAC license in the state of WI (CSAC preferred).
• Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs) desired.
• Previous experience in Utilization Management-Review preferred.
• Excellent computer skills.
• Excellent interpersonal, oral, and written communication skills.
• Ability to meet deadlines and manage priorities with minimal direct supervision.
• Experience working with various partners or team members toward shared goals.
• Ability to communicate effectively and interpret policies and procedures.

Responsibilities

• 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.

Skills

Interpersonal communication

Oral and written communication

Time management

Independent working

Education

WI LPC/LCSW/LMFT license (or eligible)

WI CSAC/SAC license

Master's degree in counseling, social work, marriage & family therapy

Job description

Gainwell Technologies is seeking a Behavioral Health prior authorization specialist to adjudicate submissions and ensure medical necessity per state guidelines. Role focuses on utilization review with no direct patient contact, including adult and child services in Medicaid-related programs.

Requirements include a Master’s in a relevant field and 5+ years of clinical experience, with active WI licenses (LPC/LCSW/LMFT or CSAC/SAC).