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 stakeholders.

Key responsibilities

• Evaluate medical necessity and eligibility for prior authorization requests in accordance with state Medicaid policies
• Collaborate with providers to obtain additional information and provide education on prior authorization requirements
• Enter prior authorization determinations into the Medicaid Management Information System (MMIS) for processing

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
• Experience working with the Wisconsin Medicaid program or other state Medicaid programs
• Strong organizational skills to manage competing priorities and meet deadlines
• Ability to interpret and communicate policies and procedures effectively