Prior Authorization Nurse Analyst RN

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u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u0026nbsp;u003c/strongu003eu003c/pu003enu003cpu003eThe Prior Authorization Nurse Analyst is a work from home position that will assist in reviewing medical documentation for prior authorization requests submitted.u003c/pu003enu003cpu003eu003cstrongu003eIn this role you will:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003ePerform review of submitted documentation to assure planned services are medically necessary based on Medicare guidelines.u003c/liu003enu003cliu003eProvide written explanations for non-affirming prior authorization requests.u003c/liu003enu003cliu003eEducate the provider on documentation requirements for planned services.u003c/liu003enu003cliu003ePerform other job-related duties as assigned.u003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eThis role could be a good fit if you: u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eAre looking to move away from direct patient care and want to use your nursing knowledge in a new and different wayu003c/liu003enu003cliu003eDesire day hours with no on-call work, limited weekend work, and holidays offu003c/liu003enu003cliu003ePossess strength in defending your decision making based on your clinical knowledgeu003c/liu003enu003cliu003eAre technically strong on computersu003c/liu003enu003cliu003eAre self-motivated and work with a great degree of independenceu003c/liu003enu003cliu003eHave strong verbal and written communication skillsetsu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eYouu0026rsquo;ll benefit from this experience by:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eCollaborating with a team of both clinicians and non-cliniciansu003c/liu003enu003cliu003eDeepening your understanding of Medicare and how the program worksu003c/liu003enu003cliu003eLearning about our Hyland OnBase tool which is our content management system used for viewing electronic recordsu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eYou need to have: u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eAssociateu0026rsquo;s degree in Nursingu003c/liu003enu003cliu003eActive RN license, applicable to state of practiceu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eWe also prefer:u003cbr /u003eu003c/strongu003eu003c/pu003enu003culu003enu003cliu003eBacheloru0026rsquo;s degree in Nursing and/or related fieldu003c/liu003enu003cliu003e4 or more years of experience in clinical nursingu003c/liu003enu003cliu003eExperience with background in Medicare principles and guidelinesu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eYour team: u003c/strongu003eu0026nbsp;u003c/pu003enu003cpu003eThis team is comprised of clinical and operational staffu003c/pu003enu003cpu003eu003cstrongu003eCompensation and Benefitsu003c/strongu003eu003c/pu003enu003culu003enu003cliu003eEligible for annual Performance Bonus Programu003c/liu003enu003cliu003e401(k) with u003cstrongu003edollar-per-dollar match up to 6% of salaryu003c/strongu003eu003c/liu003enu003cliu003eCompetitive paid time offu003c/liu003enu003cliu003eHealth and dental insurance start u003cstrongu003eDAY 1u003c/strongu003eu003c/liu003enu003cliu003eVision insuranceu003c/liu003enu003cliu003eFlexible spending, dependent care, and health savings accountsu003c/liu003enu003cliu003eShort- and long-term disability, group life insuranceu003c/liu003enu003cliu003eInnovative professional and cognitive development programsu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eWho We Areu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eFounded 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 governmentu0026rsquo;s Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eLearn more about WPSu003c/strongu003eu003c/au003eu003cstrongu003e. u003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eOur Purpose and Valuesu003c/strongu003eu003c/pu003enu003cpu003eOur purpose is to make healthcare easier for those we serve. u003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eClick Hereu003c/strongu003eu003c/au003eu003c/pu003enu003cpu003eOur values u0026ndash; Customer Focused, Individual Responsibility, Mutual Respect, and Driven u0026amp; Passionate u0026ndash; are the core of who we are and how we conduct business every day.u003c/pu003enu003cpu003eu003cstrongu003eWPS Health Insuranceu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****and Veterans Healthu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Health Administrators u003c/strongu003eu003c/pu003enu003cpu003eWPS 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 u0026amp; Medicare Services, weu0026rsquo;ve served Medicare beneficiaries and their health care providers since 1966.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Health Planu003c/strongu003eu003c/pu003enu003cpu003eWPS Health Plan offers Health Maintenance Organization and Point-of-Service plans to the group and individual markets in eastern and north-central Wisconsin, plus third-party administrator services.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Specialty Benefitsu003c/strongu003eu003c/pu003enu003cpu003eEPIC Specialty Benefits provides businesses group insurance products that cover:u003c/pu003enu003culu003enu003cliu003eLifeu003c/liu003enu003cliu003eDisabilityu003c/liu003enu003cliu003eDentalu003c/liu003enu003cliu003eVisionu003c/liu003enu003cliu003eVoluntary benefitsu003c/liu003enu003c/ulu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****connected:u0026nbsp;u003c/strongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eSign up for Job Alertsu003c/strongu003eu003c/au003eu003c/pu003enu003cpu003eu003cstrongu003eFOLLOW US!u003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eFacebooku003c/au003eu003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eTwitteru003c/au003eu003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eLinkedInu003c/au003eu003c/strongu003eu003c/pu003e,EqualOpportunityEmployerDescription:Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities,PayTransparencyPolicyStatement: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),MatchScore:1.0,HasApplied:false,ApplicationJobBoardName:null,ApplicationJobBoardId:null,DateApplied:null,Salaried:true,CompensationAmount:null,PublishingStatus:1,Links:[],BehaviorCriteria:[],MotivationCriteria:[],EducationCriteria:[],LicenseAndCertificationCriteria:[],SkillCriteria:[],WorkExperienceCriteria:[],JobBoardMemberships:[{JobBoardId:cdefa8ae-f907-5c13-2775-f0106d0aa34a,PublishedInternal:true,PublishedExternal:false,ExternalPostedDate:null,InternalPostedDate:2021-09-14T16:23:06.3Z},{JobBoardId:e6da0c90-f987-63dc-99a9-fb8c9014f57e,PublishedInternal:false,PublishedExternal:true,ExternalPostedDate:2021-09-14T16:23:06.3Z,InternalPostedDate:null}],AssessmentUri:null,AssessmentStatus:null,OpportunityIsClosed:false,TravelRequired:null,TravelDescription:null,SupervisorName:null,Assessments:[],ApplicationId:null,CompensationAnnualMinimum:null,CompensationAnnualMaximum:null,CompensationHourlyMinimum:null,CompensationHourlyMaximum:null,CompensationCurrency:null});

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