Job Summary

A health services company needs applicants for an opening for a Remote Compact State Licensed Behavioral Health Prior Authorization Nurse.

Candidates will be responsible for the following:

• Reviewing authorization requests for inpatient behavioral health care per Medicare and Medicaid criteria
• Creating reduction/denial letters based on the CMO/Medical Director’s review and applicable guidelines
• Providing complete and accurate documentation specifying rational for approval

Applicants must meet the following qualifications:

• Unrestricted license as a Registered Nurse in the state of Wisconsin or compact state
• Two (2) years of experience in mental health and/or substance abuse rehabilitation
• Proficient with MS Office products including Word, Excel and Outlook
• Experience working with MCG or Interqual guidelines is preferred
• Health Plan experience working with large carriers is preferred
• Previous Medicare/Medicaid experience is preferred