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Prior Authorization Nurse (RN) Analyst (Remote Work Offered)

Company: WPS Health Solutions
Location: Madison
Posted on: October 18, 2020

Job Description:

Role Summary:

The Medical Review Nurse Analyst will assist in reviewing medical documentation for prior authorization requests submitted.

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 authorization requests.

Educate the provider on documentation requirements for planned services.

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 independence

Able to multitask, set priorities and excel at time management

Enjoy process improvement

You’ll benefit from this experience by:

Collaborating with a team of both clinicians and non-clinicians

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 guidelines

Prior authorization experience

Your Team:

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

Vision insurance

Flexible spending, dependent care, and health savings accounts

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 serve.Click Here

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:

Health Insurance

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.

http://wpshealthsolutions.com/business-units/wpshi.shtml

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 beneficiaries.

http://wpshealthsolutions.com/business-units/wpsmvh.shtml

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.

http://wpshealthsolutions.com/business-units/wpsgha.shtml

Arise

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.

http://wpshealthsolutions.com/business-units/arise.shtml

EPIC Specialty Benefits

EPIC Specialty Benefits provides businesses group insurance products that cover:

Life

Disability

Dental

Vision

Voluntary benefits

http://wpshealthsolutions.com/business-units/epicsb.shtml

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Keywords: WPS Health Solutions, Madison , Prior Authorization Nurse (RN) Analyst (Remote Work Offered), Other , Madison, Wisconsin

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