The Medical Review Nurse Analyst will assist in reviewing
medical documentation for prior authorization requests
In this role you will:
Perform review of submitted documentation to assure planned
services are medically necessary based on Medicare guidelines.
Provide written explanations for non-affirming prior
Educate the provider on documentation requirements for planned
This role could be a good fit if you:
Are looking to move away from direct patient care and want to
use your nursing knowledge in a new and different way
Desire day hours with no on-call work, limited weekend work, and
enjoy holidays off
Have strong written communication
Are technically strong on computers
Are self-motivated and work with a great degree of
Able to multitask, set priorities and excel at time
Enjoy process improvement
You’ll benefit from this experience by:
Collaborating with a team of both clinicians and
Understanding Medicare and how the program works
Learning about our Hyland OnBase tool which is our content
management system used for viewing electronic records
You need to have:
Associate degree in Nursing
Active RN license, applicable to state of practice
4 or more years of experience in clinical nursing
Remote Work Option:You may be offered to work remotely once all
training is complete and you are meeting quality and production
standards. It will take at least 3 months or more working on-site
in our Madison, WI or Omaha, NE location before the remote work
option would be considered.
We also prefer:
Bachelor’s degree in Nursing or related field
Experience with background in Medicare principles and
Prior authorization experience
This team is comprised clinical and operational staff.
Compensation and Benefits
Eligible for annual Performance Bonus Program
401(k) withdollar-per-dollar match up to 6% of salary
Competitive paid time off
Health and dental insurance startDAY 1
Flexible spending, dependent care, and health savings
Short- and long-term disability, group life insurance
Dress for your day
Innovative professional and cognitive development programs
Who We Are
WPS Health Solutions is an innovator in health insurance and a
worldwide leader in claims administration, serving millions of
beneficiaries in the United States and abroad.
Founded in 1946, WPS offers health insurance plans for
individuals, families, and seniors, and group plans for small and
large businesses. We are a world-class claims processor and program
administrator for the government’s Medicare program. And we manage
benefits for millions of active-duty and retired military personnel
and their families.
WPS has been named one of theWorld's Most Ethical Companies® by
the Ethisphere® Institute for 10 years in a row.
Learn more about WPS.
Our Purpose and Values
Our purpose is to make healthcare easier for those we
Our values– Customer Focused, Individual Responsibility, Mutual
Respect, and Driven& Passionate– are the core of who we are and how
we conduct business every day.
Links and descriptions for:
WPS Health Insurance offers high-quality health insurance plans
for individuals and families, Medicare supplement plans for
seniors, and group health plans for businesses of every size.
Military and Veterans Health
WPS Military and Veterans Health administers claims and provides
customer service and related activities for the U.S. Department of
Defense and the U.S. Department of Veterans Affairs and their
Government Health Administrators
WPS Government Health Administrators manages Medicare Part A and
Part B benefits for more than 7 million beneficiaries. As one of
the largest contractors for the Centers for Medicare& Medicare
Services, we’ve served Medicare beneficiaries and their health care
providers since 1966.
Arise Health Plan provides innovative and high-value health
plans to groups and individuals in eastern and northeastern
Wisconsin. With our quality Wisconsin-based customer service, Arise
offers health care expertise with a personal touch.
EPIC Specialty Benefits
EPIC Specialty Benefits provides businesses group insurance
products that cover:
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