Speech Therapy Consultant (Remote)

Summary

The Speech Therapy Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal Gainwell entities. Note: This is not a patient facing position.

Your role in our mission

• Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
• Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate, seeking additional information or clarification from requesting provider.
• Adjudicating Speech Therapy prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted speech/language pathology practices.
• Write appeals as they come up related to PA, HMO, and/or Speech Generating Device DME modifications or denials.

• Return provider phone messages.
• Review communications to providers and members on new/revised policies.
• Summarize clinical information from PA documentation and provide an adjudication decision (e.g., approve, return, modify, or deny), as assigned. Support analytical work related to clinical assessments and policy development.
• Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
• Evaluate and develop clinical policy recommendations, develop/strengthen working relationships with Gainwell and DHS teams.
• Participation in any applicable meetings which include Gainwell leadership, operational staff support, clinical peers, and State stakeholders.
• Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements related to the administration and application of the speech/language therapy program.

What we're looking for

• License to practice in state of Wisconsin, ASHA accreditation.
• Ability to manage multiple concurrent activities.
• Ability to make judgments in demanding situations, and to react to frequent changes in duties and volume of work.
• Ability to logically organize details.
• Comfortable accepting responsibility for medium to large scale projects involving multiple resources and spanning many months from start to finish.

What you should expect in this role

• Opportunities to travel through your work (0-10%)
• In order to effectively work as a teleworker with Gainwell, employees Broadband Internet connections, should have a minimum speed of 24MBS download and 8 MBS upload. Greater speeds will of course provide better performance.
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• Full-time Monday through Friday schedule
• To Test your internet download and upload speed:

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