Remote Behavioral Treatment Prior-Auth Reviewer (BCBA)

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

Benefits offered by this job

Vacation policy

401(k) match

Health benefits

Educational assistance

Leadership academies

Job summary

Gainwell Technologies is seeking a Behavioral Treatment Services Prior Authorization Reviewer to adjudicate Medicaid prior authorization requests for behavioral treatment services in a fully remote role. You will evaluate medical necessity and eligibility, collaborate with providers, and serve as a clinical SME for internal and external stakeholders.

This position emphasizes timely access to care, adherence to state policies, and the opportunity to grow within a company that values learning and

Qualifications

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

Responsibilities

• Review and adjudicate Medicaid prior authorization requests for behavioral treatment services.
• Evaluate medical necessity and eligibility per state policy guidelines.
• Collaborate with providers and internal/external stakeholders as a clinical SME.
• Enter determinations into MMIS for processing.
• Provide education and guidance to providers on prior authorization requirements.
• Support policy communications and respond to provider/member inquiries.
• Act as trusted clinical SME for internal and external teams.
• Support efficient, accurate, and compliant authorization processes.

Skills

BCBA license

Strong communication

Organizational skills

Cross-functional collaboration

Medicaid knowledge (Wisconsin)

Job description

Gainwell Technologies is seeking a Behavioral Treatment Services Prior Authorization Reviewer to adjudicate Medicaid prior authorization requests for behavioral treatment services in a fully remote role. You will evaluate medical necessity and eligibility, collaborate with providers, and serve as a clinical SME for internal and external stakeholders.

This position emphasizes timely access to care, adherence to state policies, and the opportunity to grow within a company that values learning and