Prior Authorization Nurse Analyst (RN) – REMOTE

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 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 government 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