Chiropractic Consultant- Wisconsin

Summary

The Chiropractic Consultant will review Medicaid Prior Authorizations based on medical necessity in accordance with State policy guidelines, provide guidance and support for Medicaid Providers when appropriate, and act as a clinical SME (or liaison) for internal Gainwell entities.

Note: This is not a patient facing position.

Your role in our mission

• Adjudicating Chiropractic and prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted dental practices.
• Reviewing and evaluating prior authorization submissions utilizing multiple computer systems, and when appropriate seeking additional information or clarification from requesting Provider
• Entering prior authorization outcome into the Medicaid Management Information System (MMIS) for processing.
• Participation in monthly meetings which include Gainwell leadership, operational staff support, clinical peers and State stakeholders.
• Providing assistance and education to the provider community related to specific prior authorization submissions, when applicable.
• Offering analysis and recommendations to Gainwell and State leadership on methods and potential process improvements related to the administration and application of the dental program.
• Review communications to providers and members on new/revised policies.

What we're looking for

Minimally qualified candidates will have:

• Current Chiropractic Degree (DC) or equivalent Certication license in the state of WI (or license from another state and ability to obtain WI license prior to position start date).
• Extensive experience in the Chiropractic field, including both the provision, delivery and appropriate pricing and coding requested services.
• Knowledge of and/or experience working with the Wisconsin Medicaid program (or other state’s Medicaid programs)
• Excellent interpersonal, oral, and written communication skills.
• Ability to meet deadlines and manage priorities with minimal direct supervision.
• Experience working with various partners or team members toward shared goals.
• Ability to communicate effectively and interpret policies and procedures.

What you should expect in this role

• Fully remote work environment.
• This is a non-patient-facing position.
• Fast-paced environment requiring strong critical thinking, organization, and attention to detail.
• Weekend hours may be flexible; however, candidates must be available to work weekends as needed to support operational requirements.

Applications will be accepted through October 9, 2026.