Wisconsin RN Consultant

Leveraging clinical expertise, the fully remote Multi Benefit Services RN Consultant in Wisconsin will review Medicaid prior authorization requests, determine medical necessity, and support providers while ensuring compliance with state policy guidelines. Key responsibilities Reviewing and adjudicating prior authorization requests based on medical necessity and eligibility requirements Summarizing clinical information and rendering authorization decisions, including approvals and denials Providing education and support to the provider community regarding authorization requirements and submissions Required qualifications Active RN license in the State of Wisconsin Experience reviewing prior authorizations and applying medical necessity criteria Knowledge of Medicaid programs and healthcare policy guidelines Strong clinical assessment and critical thinking skills Ability to interpret clinical documentation and make sound coverage determinations