Behavioral Health Utilization Review Specialist- Wisconsin (Remote)

Gainwell Technologies LLC•Any city, OH

5d•$90,900 - $129,900•Remote

About The Position

Apply your expertise to adjudicate Behavioral Health prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted best practices. Specialty areas include Substance Use Disorder Treatment, Child and Adolescent Day Treatment. Adult Mental Health Day Treatment and In- Home Family Therapy. There are no direct patient interactions for this role, rather you will provide utilization review and quality assurance.

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

Nice To Haves

CSAC 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

Responsibilities

Review and evaluate prior authorization submissions utilizing multiple computer systems, and when appropriate seek additional information or clarification from requesting providers.
Enter prior authorization outcomes into the Medicaid Management Information System (MMIS) for processing.
Participate in monthly meetings which 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, when applicable.
Offer analysis and recommendations on methods and potential process improvements related to the administration and application of medical programs that you support.
Review communications to providers and members on new/revised policies.