WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS’ Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce—both current and future—to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:
Madison, Wisconsin’s Top Workplaces
USA Top Workplaces and the cultural excellence awards for Remote Work and Work-Life Flexibility
Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment
DAV Patriot Employer
VETS Indexes 4 Star Employer
BBB Torch Award for Ethics from Better Business Bureau of Wisconsin
Role Snapshot
Our Senior Medical Review Nurse Analyst position is a work from home position and serves as a subject matter expert (SME) to clinical staff regarding Medicare regulations to ensure accurate and timely claim processing.
Additional Details
Provide in depth training on Prior Authorization topics to Facility Providers including MD’s and requesters
Plan and facilitate training events on general topics and department specific processes for large groups, small groups and individuals.
Provide on the floor performance support after training, and document completed training activities.
Develop and update written work instructions.
Review and recommend policy changes when appropriate and update training materials in response to Centers for Medicare and Medicaid Services (CMS) regulatory changes and/or changes in Local Coverage Determinations.
Perform post training quality analysis reviews and determine when a trainee can be released based on post training assessment.
Participate in and assist with development of provider education and training activities.
Evaluate and report employee progress and training feedback to business unit leads within defined Service Level Agreements when assisting with training.
Develop, implement, and perform quality assurance activities, record scores in NICE (Employee Engagement Manager tool), and monitor results.
Collaborate with business units, contract medical directors, and subject matter experts on new CMS issued directives.
How do I know this opportunity is right for me? If you:
Desire day hours with no on-call work and holidays off
Have strong verbal and written communication
Enjoy teaching and training providers and Prior Authorization requesters
Are technically strong on computers
Are self-motivated and work with a great degree of independence
Have the ability to multitask, set priorities and excel at time management
Enjoy process improvement
What will I gain from this role?
Building your indirect leadership skills
Collaborating with other team members that are both clinicians and non-clinicians
Staying connected with providers
Continuous performance feedback
Experience working in an environment that serves Medicare Beneficiaries
Minimum Qualifications
Bachelor’s Degree in related field or equivalent post high school and/or related work experience
Active RN license, applicable to state of practice
Preferred Qualifications
4 or more years of experience in clinical nursing
Bachelor’s Degree in Nursing
2 or more years of leadership and/or training experience
2 or more years of Nurse Analyst experience with background in Medicare principles and guidelines
Remote Work Requirements
Wired (ethernet cable) internet connection from your router to your computer
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
Salary Range
$74,000 to $77,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
Work Location
We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin