Job description
It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
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.
Your role in our mission
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.
What we're looking for
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.
What you should expect in this role
Fully remote work environment.
Fast-paced environment requiring strong critical thinking, organization, and attention to detail.
Weekend hours may be flexible; however, candidates must be available to work weekends as needed to support operational requirements.
Applications will be accepted through October 9, 2026.
The pay range for this position is $90,900.00 - $129,900.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.