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Who We Are

WPS Health Solutions is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service 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. In 2021, WPS Health Solutions celebrates 75 years of making health insurance easier for those we serve. Proud to be military and veteran ready.

Our Culture

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, empowering employee experience, focusing on People, Work, and Conditions. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are guided by our Purpose: Together, making health care easier for the people we serve.

From 2021 to 2023 WPS Health Solutions has been recognized for several awards including:

• 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

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 Nation’s military, veterans, Guard and Reserves and Medicare beneficiaries
• Continuous performance feedback

Minimum Qualifications

• Bachelor’s Degree in related field or equivalent post high school (associates)and/or related work experience
• Active RN license, applicable to state of practice
• Fiber or cable high speed internet service (satellite internet or hot spots are NOT acceptable) that meet our remote work requirements including having a designated work station, a wired Ethernet connection (NOT wireless internet) to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net). If you do not currently have high speed cable or fiber internet but are able to obtain it prior to the start date, that is acceptable (as long as it meets our upstream and downstream connection requirements previously mentioned).

Preferred Qualifications

• Prior authorization, utilization management, or medical/chart review experience
• Bachelor’s degree in Nursing
• 4 or more years of experience in clinical nursing
• Experience with background in Medicare principles and guidelines

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 Hours

• This is a full-time salaried position.
• Monday through Friday with some flexibility on the start and end time as long as your 8 hour day falls between 6:00 AM CST and 6:00 PM CST.

Work Location

This role is open to remote work for this opportunity 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

Remote Work Equipment

Computer equipment necessary to perform in this remote role will be provided and mailed to you via UPS.

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, dental insurance, Teladoc starts DAY 1
• Review additional benefits here

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)