Wisconsin Licensed Prior Authorization RN

Job Summary

Working remotely, the full-time Wisconsin Licensed Prior Authorization RN will review prior authorization requests for Personal Care Services and Private Duty Nursing within Medicaid programs, ensuring compliance with state policies and clinical standards.

Key responsibilities

• Reviewing and adjudicating prior authorization requests based on medical necessity and eligibility
• Evaluating clinical documentation and collaborating with providers to obtain necessary information
• Serving as a clinical subject matter expert and providing education on prior authorization requirements

Required qualifications

• Bachelor's degree in Nursing or equivalent education and experience
• Current RN license in Wisconsin or ability to obtain prior to start date
• Minimum of 5 years of nursing experience
• Prior Authorization and/or Utilization Review experience
• Knowledge of Wisconsin Medicaid or other state Medicaid programs preferred