Behavioral Treatment Consultant

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. 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. 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. Apply clinical expertise to evaluate medical necessity and eligibility in accordance with state Medicaid policies and guidelines. 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. 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. 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. Fully remote work environment. Weekend hours may be flexible; however, candidates must be available to work weekends as needed to support operational requirements. Applications will be accepted through November 2, 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. 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. 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.