Prior Authorization Nurse Specialist

6 days ago


Indianapolis, Indiana, United States WPS Health Solutions Full time

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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