It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. 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. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
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.
Primary Job Responsibilities
- 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.
- Ability to communicate effectively and interpret policies and procedures.
What you should expect in this role
- Work Location: Remote within the United States
- Travel Requirement: 0–10% travel may be required
Application Deadline: Applications will be accepted through May 5, 2026.
The pay range for this position is $64,500.00 - $92,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. 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. Build your career with Gainwell, an industry leader. 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.
