Behavioral Health Utilization Review Specialist

🕒 Yesterday

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Adjudicate Behavioral Health prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted best practices • Review and evaluate prior authorization submissions using multiple computer systems • Seek additional information or clarification from requesting providers when appropriate • Enter prior authorization outcomes into the Medicaid Management Information System (MMIS) for processing • Participate in monthly meetings with 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 • Analyze and recommend methods and potential process improvements related to supported medical programs • Review communications to providers and members on new or revised policies • Provide utilization review and quality assurance without direct patient interactions

🎯 Requirements

• 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

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies • 100% remote home office