- 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.
- 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
- 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
- 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
- Prior authorization, utilization management, or medical/chart review experience
- Bachelor's degree in Nursing
- 4 or more years of experience in clinical nursing
- Understanding of Medicare government insurance
- 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 )
- Please review for additional information
- This is a full-time salaried exempt position.
- Monday through Friday with some flexibility on the start and end time as long as your daily consecutive
- Training is approximately one month and the new hire can chose training hours of Monday through Friday from 7:00 AM to 3:30 PM CST or 8:00 AM to 4:30 PM CST.
- 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
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Prior Authorization Nurse Analyst - Detroit, United States - WPS Health Solutions
Description
Who We Are
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 . Proud to be military and veteran ready.
Culture Drives Our Success
WPS' 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.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace:
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:
How do I know this opportunity is right for me? If you:
What will I gain from this role?
Minimum Qualifications
Preferred Qualifications
Remote Work Requirements
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
8 hour day falls between 6:00 AM CST and 6:00 PM CST.
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
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WPS Health Blog
Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe 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 c)
Prior Authorization Nurse Analyst professionals in Detroit
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Brian Shaw
Senior Director, Enterprise Risk Management