Remote Behavioral Treatment Reviewer

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

Benefits offered by this job

Flexible vacation policy

401(k) match

Healthcare benefits

Educational assistance

Job summary

Gainwell Technologies LLC is seeking a Behavioral Treatment Services Prior Authorization Reviewer for a fully remote role in Wisconsin. The incumbent will review Medicaid prior authorization requests for behavioral treatment services, assess medical necessity, and determine eligibility per state guidelines.

In this role, you will collaborate with providers and internal teams to support timely access to care, educate on requirements, and ensure compliant processes while maintaining high-quality

Qualifications

• Minimum 5 years of Behavioral Treatment experience.
• Current BCBA license in Wisconsin, or licensure in another state with ability to obtain Wisconsin licensure before the 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.

Responsibilities

• Ensure Medicaid members receive timely access to appropriate behavioral treatment services through accurate and consistent prior authorization reviews.
• Apply clinical expertise to evaluate medical necessity and eligibility in accordance with state Medicaid policies and guidelines.
• Review and evaluate prior authorization submissions and obtain additional information or clarification from providers when necessary.
• Enter prior authorization determinations into the Medicaid Management Information System (MMIS) for processing.
• Provide education, guidance, and support to providers regarding prior authorization requirements and submissions.
• Review provider and member communications related to new or revised policies.
• Serve as a trusted clinical subject matter expert for providers, internal teams, and external stakeholders.
• Contribute to operational excellence by supporting efficient, accurate, and compliant authorization processes.

Skills

Behavioral treatment experience

Licensure eligibility Wisconsin

Education

BCBA license

Job description

Gainwell Technologies LLC is seeking a Behavioral Treatment Services Prior Authorization Reviewer for a fully remote role in Wisconsin. The incumbent will review Medicaid prior authorization requests for behavioral treatment services, assess medical necessity, and determine eligibility per state guidelines.

In this role, you will collaborate with providers and internal teams to support timely access to care, educate on requirements, and ensure compliant processes while maintaining high-quality