Behavioral Health Utilization Review Specialist

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Evaluate Behavioral Health prior authorizations based on medical necessity and eligibility, adhering to State policy guidelines and recognized best practices.

• Assess and analyze prior authorization requests utilizing various computer systems.

• Obtain additional information or clarification from requesting providers when necessary.

• Record prior authorization results into the Medicaid Management Information System (MMIS) for processing.

• Engage in monthly meetings with leadership, operational staff, clinical colleagues, and stakeholders from the State of Wisconsin.

• Offer support and education to the provider community concerning specific prior authorization requests.

• Examine and suggest methods and potential enhancements related to supported medical programs.

• Review communications directed to providers and members regarding new or updated policies.

• Conduct utilization review and quality assurance activities without direct patient interactions.

⛳️ Requirements

• A Master's degree in counseling, social work, marriage and family therapy, or a related field.

• At least 5 years of clinical work experience.

• A current LPC, LCSW, or LMFT license in the state of WI, or a license from another state with the ability to obtain a WI license before starting the position.

• CSAC or SAC license in the state of WI (CSAC preferred).

• Familiarity with and/or experience in the Wisconsin Medicaid program or other state Medicaid programs is preferred.

• Prior experience in Utilization Management-Review is preferred.

• Strong computer skills.

• Exceptional interpersonal, oral, and written communication abilities.

• Capable of meeting deadlines and managing priorities with minimal supervision.

• Experience collaborating with various partners or team members to achieve shared objectives.

• Proficient in effective communication and interpreting policies and procedures.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• 100% remote home office.