Prior Authorization Nurse Analyst (RN) - REMOTE
This a Full Remote job, the offer is available from: United States
Who We Are
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 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 workforceboth current and futureto 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, Wisconsins 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 Full-time Prior Authorization Nurse Analyst Is a Work From Home Position That Will Assist In Reviewing Medical Documentation For Prior Authorization Requests Submitted. Additional Details
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.
How do I know this opportunity is right for me? 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 and holidays off
Possess strength in defending your decision making based on your clinical knowledge
Are technically strong on computers
Are self-motivated and work with a great degree of independence
Have strong verbal and written communication skillsets
What will I gain from this role?
Collaborating with a team of both clinicians and non-clinicians
Deepening your understanding of Medicare and how the program works
Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records
Experience working in an environment that serves our Nations military, veterans, Guard and Reserves and Medicare beneficiaries
Continuous performance feedback
Minimum Qualifications
Associates or Bachelors Degree in Nursing
Active RN license, applicable to state of practice
Preferred Qualifications
Bachelors degree in Nursing
Prior authorization, utilization management, or medical/chart review experience
4 or more years of experience in clinical nursing
Knowledge in government 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)
Please review Remote Worker FAQs for additional information
Salary Range
$66,000 to $68,000
_The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
_ Work Schedule
Full-Time, Salaried
Monday through Friday, Day Hours
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 **
Benefits**
Remote work option available
Performance bonus and/or merit increase opportunities
401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Employee Resource Groups
Professional and Leadership Development Programs
Review additional benefits here
Sign up for Job Alerts
FOLLOW US!
Instagram
LinkedIn
Facebook
WPS Health Blog
This offer from "WPS Health Solutions" has been enriched by Jobgether.com and got a 72% flex score.
Apply Now
Who We Are
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 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 workforceboth current and futureto 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, Wisconsins 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 Full-time Prior Authorization Nurse Analyst Is a Work From Home Position That Will Assist In Reviewing Medical Documentation For Prior Authorization Requests Submitted. Additional Details
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.
How do I know this opportunity is right for me? 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 and holidays off
Possess strength in defending your decision making based on your clinical knowledge
Are technically strong on computers
Are self-motivated and work with a great degree of independence
Have strong verbal and written communication skillsets
What will I gain from this role?
Collaborating with a team of both clinicians and non-clinicians
Deepening your understanding of Medicare and how the program works
Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records
Experience working in an environment that serves our Nations military, veterans, Guard and Reserves and Medicare beneficiaries
Continuous performance feedback
Minimum Qualifications
Associates or Bachelors Degree in Nursing
Active RN license, applicable to state of practice
Preferred Qualifications
Bachelors degree in Nursing
Prior authorization, utilization management, or medical/chart review experience
4 or more years of experience in clinical nursing
Knowledge in government 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)
Please review Remote Worker FAQs for additional information
Salary Range
$66,000 to $68,000
_The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
_ Work Schedule
Full-Time, Salaried
Monday through Friday, Day Hours
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 **
Benefits**
Remote work option available
Performance bonus and/or merit increase opportunities
401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Employee Resource Groups
Professional and Leadership Development Programs
Review additional benefits here
Sign up for Job Alerts
FOLLOW US!
WPS Health Blog
This offer from "WPS Health Solutions" has been enriched by Jobgether.com and got a 72% flex score.
Apply Now