Behavioral Health Utilization Review Specialist

Gainwell Technologies

. Adjudicate Behavioral Health prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted best practices .

Posted 10/27/2026full-timeRemote • Wisconsin • United StatesMid-LevelSenior💰 $90,900 - $129,900 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Behavioral Health Prior Authorization processes, including utilization review and quality assurance, while effectively communicating with providers and stakeholders. Holds relevant licenses and possesses strong analytical skills to recommend process improvements within Medicaid programs.

Highest-signal resume keywords

Master's Degree In CounselingLPC License In WisconsinLCSW License In WisconsinUtilization Management ExperienceKnowledge Of Wisconsin Medicaid Program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Behavioral Health Prior AuthorizationUtilization ReviewQuality AssuranceProcess Improvement AnalysisMedicaid Management Information System (MMIS)Clinical Work ExperiencePrior Authorization Submission EvaluationPolicy InterpretationMedical Necessity AssessmentEligibility Determination

Soft Skills

Excellent Interpersonal SkillsOral Communication SkillsWritten Communication SkillsDeadline ManagementTeam Collaboration

Tools & Technologies

Computer SystemsMedicaid Management Information System (MMIS)

Certifications & Qualifications

LPC LicenseLCSW LicenseLMFT LicenseCSAC LicenseSAC License

Industry Keywords

Behavioral HealthPrior AuthorizationUtilization ManagementWisconsin Medicaid ProgramClinical Experience

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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