Prior Authorization Nurse Analyst (RN) - REMOTE
Posted 2025-04-06This 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**
WPSÂ 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 workforceÂboth current and futureÂto 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, WisconsinÂs 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 ÂElite 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 NationÂs military, veterans, Guard and Reserves and Medicare beneficiaries
 Continuous performance feedback
Minimum Qualifications
 AssociateÂs or BachelorÂs Degree in Nursing
 Active RN license, applicable to state of practice
Preferred Qualifications
 BachelorÂs 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
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