Loading...
Share this Job

EVV RN Consultant

Date: Oct 21, 2021

Location: Madison, WI, US, 53784-0001

Company: Gainwell Technologies LLC

Job Description

The EVV RN 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.
 
Primary Job Responsibilities: 
• Adjudicating EVV prior authorizations based on medical necessity and eligibility, in accordance with State policy guidelines and accepted speech/language pathology 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 any applicable 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 EVV program. 
• Review communications to providers and members on new/revised policies. 
• Return provider phone messages.

Other 
•    Summarize clinical information from PA documentation and provide an adjudication decision (e.g., approve, return, modify, or deny), as assigned. Support analytical work related to clinical assessments and policy development. 
•    Evaluate and develop clinical policy recommendations, develop/strengthen working relationships with Gainwell and DHS teams. 
•    Ability to make judgments in demanding situations. 
•    Ability to react to frequent changes in duties and volume of work.
•    Ability to logically organize details.
•    Comfortable accepting responsibility for medium to large scale projects involving multiple resources and spanning many months from start to finish.
•    Ability to manage multiple concurrent activities.

Licenses and Certifications: 
Minimum – RN License in the State of Wisconsin

Qualifications

Summary