Behavioral Health Utilization Review Specialist
New
G
Gainwell TechnologiesHealthcare Administration
United StatesFull-TimeMiddle
Salary90,900 - 129,900 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 5 years clinical work experience
Requirements
- Master's degree in counseling, social work, marriage and family therapy, or equivalent.
- Minimum of 5 years of clinical work experience.
- Current LPC, LCSW, or LMFT license in the state of WI (or ability to obtain prior to start).
- CSAC or SAC license in the state of WI (CSAC 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.
- Knowledge of or experience working with the Wisconsin Medicaid program or other state Medicaid programs (desired).
Responsibilities
- Review and evaluate prior authorization submissions utilizing 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, clinical peers, and State of Wisconsin stakeholders.
- Provide assistance and education to the provider community related to specific prior authorization submissions.
- Offer analysis and recommendations on methods and potential process improvements related to medical programs.
- Review communications to providers and members on new or revised policies.
View Full Description & ApplyYou'll be redirected to the employer's site
