Registered Nurse – Multiple Benefit Coverage

🔥 0 minutes ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Review and adjudicate Medicaid prior authorization requests across multiple service areas • Evaluate prior authorization submissions and obtain additional information or clarification from providers • Summarize clinical information and render authorization decisions, including approvals, modifications, returns, or denials • Enter authorization outcomes into the Medicaid Management Information System (MMIS) • Serve as a clinical subject matter expert and resource for providers, internal teams, and state stakeholders • Provide education and support to providers regarding authorization requirements and submissions • Participate in meetings with leadership, operational staff, clinical peers, and state partners • Support clinical policy development and recommend program and process improvements • Review provider and member communications related to new or revised policies • Respond to provider inquiries and return provider phone messages • Build and maintain collaborative relationships with Gainwell and state agency partners

🎯 Requirements

• 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 • Excellent interpersonal, verbal, and written communication skills • Experience working with multiple computer systems and applications • Strong organizational skills with the ability to manage multiple priorities and concurrent activities • Ability to work independently and adapt to changing priorities and workloads • Experience collaborating with providers, internal teams, and external stakeholders • Ability to contribute to policy development, process improvement initiatives, and complex projects • Must be available to work weekends as needed

🏖️ Benefits

• Flexible hours • Work-life balance • Continuous learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies