[Hiring] Durable Medical Equipment Consultant @Gainwell Technologies LLC

Role Description

The Durable Medical Equipment 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.

• Adjudicating Durable Medical Equipment and prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted dental practices.
• Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider.
• Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
• Participation in monthly meetings which include Gainwell leadership, operational staff support, clinical peers and State stakeholders.
• Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
• Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements related to the administration and application of the dental program.
• Review communications to providers and members on new/revised policies.

Qualifications

• Current Occupational Therapy, Physical Therapy or RN license in the state of WI (or license from another state and ability to obtain WI license prior to position start date).
• Extensive experience in the DME field, including both the provision, delivery and appropriate pricing and coding of durable medical equipment.
• Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs).
• 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.

Requirements

• Work Location: Remote within the United States.
• Travel Requirement: 0–10% travel may be required.
• Application Deadline: Applications will be accepted through July 6, 2026.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.