Wisconsin Licensed RN Consultant

Job Summary

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

Key responsibilities

• Review and adjudicate prior authorization requests based on medical necessity and eligibility
• Evaluate clinical documentation and collaborate with providers to obtain necessary information
• Provide 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 ability to obtain it 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