Remote Behavioral Health Utilization Reviewer

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

Benefits offered by this job

Health benefits

401(k) employer match

Generous vacation policy

Educational assistance

Job summary

Gainwell Technologies is seeking a Behavioral Health Prior Authorization reviewer to adjudicate submissions for Substance Use Disorder Treatment, Child and Adolescent Day Treatment, and Adult Mental Health Day Treatment. This 100% remote role involves utilization review and quality assurance with no direct patient contact.

You will review submissions, enter outcomes in MMIS, and participate in stakeholder meetings, ensuring compliance with state policies and best practices.

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 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 with leadership, operational staff, 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

Time management

Policy interpretation

Adaptability

Team collaboration

Education

Master's degree in counseling or social work

State licenses: LPC/LCSW/LMFT (WI)

CSAC or SAC license (WI)

Job description

Gainwell Technologies is seeking a Behavioral Health Prior Authorization reviewer to adjudicate submissions for Substance Use Disorder Treatment, Child and Adolescent Day Treatment, and Adult Mental Health Day Treatment. This 100% remote role involves utilization review and quality assurance with no direct patient contact.

You will review submissions, enter outcomes in MMIS, and participate in stakeholder meetings, ensuring compliance with state policies and best practices.