Prior Authorization Nurse Specialist
6 days ago
About the Role
We are seeking a skilled Prior Authorization Nurse Analyst to join our team at WPS Health Solutions. As a Prior Authorization Nurse Analyst, you will play a critical role in reviewing medical documentation for prior authorization requests submitted to our organization.
Key Responsibilities
- Review medical documentation to ensure planned services are medically necessary based on Medicare guidelines.
- Provide written explanations for non-affirming prior authorization requests.
What You'll Gain
- Collaborate with a team of clinicians and non-clinicians to ensure high-quality patient care.
- Deepen your understanding of Medicare and its guidelines.
- Gain experience working in an environment that serves our Nation's military, veterans, Guard, and Reserves, and Medicare beneficiaries.
- Receive continuous performance feedback to help you grow in your role.
Requirements
- Bachelor's Degree in a related field or equivalent post-high school education and/or related work experience.
- Active RN license, applicable to the state of practice.
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.
- Understanding of Medicare government insurance.
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.
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.
Equal Opportunity Employer
WPS Health Solutions is an equal opportunity employer and welcomes applications from diverse candidates.
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