Home Health Registered Nurse

To support Medicaid members in receiving necessary services, the remote Wisconsin Licensed Personal Care RN will review prior authorization requests, determine medical necessity, and ensure compliance with state policy guidelines while collaborating with providers and stakeholders. Key responsibilities Review and adjudicate prior authorization requests based on medical necessity and state policy guidelines Evaluate clinical documentation and collaborate with providers to obtain necessary information Serve as a clinical subject matter expert, providing education and guidance to the provider community Required qualifications Bachelor's degree in Nursing or equivalent combination of education and experience Current RN license in Wisconsin or ability to obtain Wisconsin licensure Minimum of 5 years of nursing experience Prior Authorization and/or Utilization Review experience Knowledge of Wisconsin Medicaid or other state Medicaid programs preferred