Prior Authorization Behavioral Treatment Consultant- Wisconsin

Gainwell Technologies LLC•Any city, OH

4d•$90,900 - $129,900•Remote

About The Position

Join our team as a Behavioral Treatment Services Prior Authorization Reviewer, where you will leverage your clinical expertise to review and adjudicate Medicaid prior authorization requests for behavioral treatment services. In this fully remote role, you will evaluate requests for medical necessity and eligibility in accordance with state policy guidelines, collaborate with providers, and serve as a clinical subject matter expert supporting both internal and external stakeholders. This position offers the opportunity to make a meaningful impact on members' access to care while working alongside a highly skilled and supportive team.

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.

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.