Prior Authorization Behavioral Treatment Consultant

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

📋 Description

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

• Analyze requests for medical necessity and eligibility in accordance with state policy guidelines.

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

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

• Educate, guide, and assist providers regarding the requirements and submission processes for prior authorizations.

• 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.

• Promote efficient, accurate, and compliant authorization processes.

⛳️ Requirements

• At least 5 years of experience in Behavioral Treatment.

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

• Exceptional interpersonal, verbal, and written communication skills.

• Proficient in interpreting and conveying policies and procedures effectively.

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

• Experience working collaboratively with cross-functional teams and stakeholders.

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

• Willingness to work weekends as necessary.

🏝️ Benefits

• Flexible hours.

• Work-life balance.

• Opportunities for continuous learning and career development.

• Flexible vacation policy.

• 401(k) employer match.

• Comprehensive health benefits.

• Educational assistance.

• Access to leadership and technical development academies.