Remote Behavioral Treatment PA Reviewer

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

Benefits offered by this job

Flexible vacation policy

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking an experienced Behavioral Treatment Services Prior Authorization Reviewer to evaluate Medicaid prior authorization requests for behavioral treatment services. This fully remote role focuses on medical necessity and eligibility in line with state policy guidelines, collaborating with providers and internal/external stakeholders to ensure timely access to care.

The ideal candidate has at least 5 years in Behavioral Treatment, a BCBA license (or eligible for

Qualifications

• Minimum of 5 years of Behavioral Treatment experience.
• Current BCBA license in Wisconsin, or licensure in another state with ability to obtain Wisconsin licensure prior to start date.
• Excellent interpersonal, verbal, and written communication skills.
• Ability to interpret and communicate policies and procedures.
• Strong organizational skills with the ability to manage competing priorities and meet deadlines with minimal supervision.
• Experience collaborating with cross-functional teams and stakeholders.
• Knowledge of Wisconsin Medicaid or other state Medicaid programs.

Responsibilities

• Ensure Medicaid members receive timely access to behavioral treatment services through accurate prior authorization reviews.
• Apply clinical expertise to evaluate medical necessity and eligibility per state Medicaid policies.
• Review prior authorization submissions and request additional information when needed.
• Enter determinations into MMIS for processing.
• Provide education and guidance to providers on prior authorization requirements.
• Review provider and member communications related to policies.
• Serve as clinical SME for providers and internal/external stakeholders.
• Support efficient, accurate, compliant authorization processes.

Skills

Behavioral Treatment

Interpersonal communication

Verbal communication

Written communication

Education

BCBA licensure

Job description

Gainwell Technologies is seeking an experienced Behavioral Treatment Services Prior Authorization Reviewer to evaluate Medicaid prior authorization requests for behavioral treatment services. This fully remote role focuses on medical necessity and eligibility in line with state policy guidelines, collaborating with providers and internal/external stakeholders to ensure timely access to care.

The ideal candidate has at least 5 years in Behavioral Treatment, a BCBA license (or eligible for