Behavioral Treatment Consultant

Gainwell Technologies

. Review and adjudicate Medicaid prior authorization requests for behavioral treatment services .

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 Medicaid prior authorization processes, including evaluation of medical necessity and eligibility, while providing education and support to providers. Strong organizational and communication skills are essential for managing competing priorities and collaborating with cross-functional teams.

Highest-signal resume keywords

Behavioral Treatment ExperienceBCBA LicenseMedicaid Management Information System (MMIS)Wisconsin Medicaid Program KnowledgeInterpersonal Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Prior Authorization ReviewMedical Necessity EvaluationEligibility AssessmentPolicy InterpretationDocumentation Management

Soft Skills

Organizational SkillsVerbal CommunicationWritten CommunicationCollaborationProblem-Solving

Certifications & Qualifications

BCBA License

Industry Keywords

MedicaidBehavioral Treatment ServicesPrior AuthorizationClinical Subject Matter ExpertCompliance

About the role

Key responsibilities & impact

Review and adjudicate Medicaid prior authorization requests for behavioral treatment services
Evaluate requests for medical necessity and eligibility in accordance with 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

What you’ll need

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

Comp & perks

Flexible hours
Work-life balance
Continuous learning and career development
Generous, flexible vacation policy
401(k) employer match
Comprehensive health benefits
Educational assistance
Leadership and technical development academies