Behavioral Treatment Consultant

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Review and adjudicate Medicaid prior authorization requests for behavioral treatment services • Evaluate requests for medical necessity and eligibility according to state Medicaid policies and guidelines • Review prior authorization submissions and obtain additional information or clarification from providers when necessary • Enter prior authorization determinations into the Medicaid Management Information System (MMIS) • 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 clinical subject matter expert for providers, internal teams, and external stakeholders • Support efficient, accurate, and compliant authorization processes

🎯 Requirements

• Minimum of 5 years of Behavioral Treatment experience • Current BCBA license in the state of Wisconsin, or licensure in another state with the ability to obtain Wisconsin licensure prior to the start date • Excellent interpersonal, verbal, and written communication skills • Ability to effectively 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 to achieve shared goals • Knowledge of and/or experience working with the Wisconsin Medicaid program or other state Medicaid programs • Availability to work weekends as needed to support operational requirements

🏖️ 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 • Work flexibility