Behavioral Treatment Consultant

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Assess and adjudicate Medicaid prior authorization requests for behavioral treatment services.

• Analyze requests for medical necessity and eligibility in line with state Medicaid policies and guidelines.

• Review prior authorization submissions and gather additional information or clarification from providers as needed.

• Input prior authorization decisions into the Medicaid Management Information System (MMIS).

• Offer education, guidance, and support to providers regarding prior authorization requirements and submissions.

• Examine communications from providers and members related to new or updated policies.

• Act as a clinical subject matter expert for providers, internal teams, and external stakeholders.

• Facilitate efficient, accurate, and compliant authorization processes.

⛳️ Requirements

• At least 5 years of experience in Behavioral Treatment.

• Current BCBA license in Wisconsin, or licensure in another state with the capability to secure Wisconsin licensure before the start date.

• Exceptional interpersonal, verbal, and written communication skills.

• Proficiency in effectively interpreting and conveying policies and procedures.

• Strong organizational abilities with the capacity to manage competing priorities and meet deadlines with minimal oversight.

• Proven experience collaborating with cross-functional teams and stakeholders to achieve common objectives.

• Familiarity with and/or experience working within the Wisconsin Medicaid program or other state Medicaid programs.

• Willingness to work weekends as necessary to meet operational demands.

🏝️ Benefits

• Flexible working hours.

• Work-life balance.

• Opportunities for continuous learning and career advancement.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits.

• Educational assistance.

• Access to leadership and technical development academies.