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 accordance with state Medicaid policies and guidelines.

• Evaluate prior authorization submissions and request additional information or clarification from providers when required.

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

• Offer education, guidance, and assistance to providers regarding prior authorization requirements and submission processes.

• Review communications from providers and members concerning 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 interpreting and conveying policies and procedures effectively.

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

• Experience in collaborating with cross-functional teams and stakeholders to achieve common objectives.

• Knowledge of and/or experience with the Wisconsin Medicaid program or other state Medicaid programs.

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

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Continuous learning and career development opportunities.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Leadership and technical development academies.

• Work flexibility.