Wisconsin Licensed RN Consultant

Job Summary

Working remotely in a flexible environment, the Wisconsin Licensed RN Consultant 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 state policy guidelines
• Evaluating clinical documentation and collaborating with providers to obtain necessary information
• Providing education and guidance to the provider community regarding prior authorization requirements

Required qualifications

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