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Medicaid Clinical Service Authorization Representative

Date:  Aug 6, 2022

Anchorage, AK, US, 99503

Req ID:  11693

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at HMS, a Gainwell Company carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.


HMS, a Gainwell Technologies Company
HMS is hiring Medicaid Clinical Service Authorization Representatives are responsible for taking incoming calls, providing excellent customer service, working service authorization, and ensuring that quality and timeliness standards are achieved. 

Your role in our mission

•    Assists members and providers with clinical service authorizations based on the State's policies and procedures and approved clinical practice guidelines and review criteria. 
•    Ensures that the appropriate medical record documentation is received for all clinical service authorizations. 
•    Meets turnaround times and other quality measures on a routine basis. 
•    Refers service authorization requests for MDR review as appropriate. 
•    Responsible for reaching goals and quality daily.
•    Other duties as assigned. 

What we’re looking for

•    RN or LPN with equivalent work experience with current and active licensure in the United States. Must practice within the scope of the licensure.
•    Minimum of two years of Medicaid experience or other health care experience preferred. Previous experience with service authorization/utilization management, preferred.
•    Ability to solve practical problems and deal with a variety of concrete variables in situations where some standardization exists; ability to collect and analyze data, draw valid conclusions, and actively contribute to the strategic interventions that support the departmental goals. 
•    Solid interpersonal skills, strong communication skills, impeccable professionalism and respect for all individuals. Ability to manage time and prioritize tasks. 
•    Strong organizational skills; attentiveness to details; highly motivated with the ability to multi-task. Ability to communicate, facilitate, and problem solve with internal and external customers.

What you should expect in this role


In-Office/Work-from-Home Hybrid

Work-from-home (WFH); or Hybrid model including in-office and WFH days to be defined. For positions assigned to WFH, reliable high-speed internet connectivity is required.  Employees working-from-home may be required to report to the office, at times, to support work efforts.  


The pay range for this position is $70,600.00 - $88,200.00 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 HMS, a Gainwell Company. 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 HMS, a Gainwell Company, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about HMS, A Gainwell Technologies Company at our company website and visit our Careers site for all available job role openings.


HMS, a Gainwell Company is committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

Nearest Major Market: Alaska
Nearest Secondary Market: Anchorage

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