at WPS Health Solutions in Marion, Illinois, United States
Job Description
Description
Who We Are
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 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:
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 ). 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
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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... For full info follow application link.
Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.
