Wisconsin Licensed Behavioral Consultant

Job Summary

Leveraging clinical expertise, the fully remote Wisconsin Licensed Behavioral Consultant will review and adjudicate Medicaid prior authorization requests for behavioral treatment services, ensuring timely access to care while collaborating with providers and supporting internal and external stakeholders.

Key responsibilities

• Evaluate medical necessity and eligibility for Medicaid prior authorization requests in accordance with state policy guidelines
• Collaborate with providers to obtain additional information or clarification regarding prior authorization submissions
• Serve as a clinical subject matter expert, providing education and guidance on prior authorization requirements and processes

Required qualifications

• Minimum of 5 years of Behavioral Treatment experience
• Current BCBA license in Wisconsin or ability to obtain it prior to the start date
• Knowledge of Wisconsin Medicaid program or other state Medicaid programs
• Experience collaborating with cross-functional teams and stakeholders
• Strong organizational skills to manage competing priorities and deadlines