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 criteria.

• Review and assess prior authorization requests utilizing various computer systems.

• Request additional information or clarification from providers when deemed necessary.

• Input prior authorization results into the Medicaid Management Information System (MMIS).

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

• Offer support and education to providers concerning specific prior authorization requests.

• Analyze and suggest enhancements related to medical programs supported.

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

• Conduct utilization review and quality assurance without direct interaction with patients.

⛳️ Requirements

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

• At least 5 years of clinical work experience.

• Valid LPC, LCSW, or LMFT license in Wisconsin, or a license from another state with the ability to obtain Wisconsin licensure before the start date.

• CSAC or SAC license in Wisconsin (CSAC preferred).

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

• Prior experience in Utilization Management-Review is an advantage.

• Strong computer proficiency.

• Exceptional interpersonal, oral, and written communication abilities.

• Capability to meet deadlines and manage priorities with minimal supervision.

• Experience collaborating with various partners or team members to achieve common goals.

• Skill in effective communication and interpretation of policies and procedures.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and professional development opportunities.

• 100% remote home office.

• Flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.