Prior Authorization Nurse Specialist

3 weeks ago


Madison, Wisconsin, United States WPS Inc Full time
Job Summary

WPS Health Solutions is seeking a skilled Prior Authorization Nurse Analyst to join our team. 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.

Requirements

Bachelor's Degree in a related field or equivalent experience.
Active RN license, applicable to the state of practice.
Prior authorization, utilization management, or medical/chart review experience preferred.

What We Offer

Competitive salary range of $66,000 to $68,000.
Remote work option available in approved states.
Performance bonus and/or merit increase opportunities.
401(k) with dollar-per-dollar match up to 6% of salary.
Competitive paid time off.
Health insurance, dental insurance, and telehealth services start DAY 1.

About WPS Health Solutions

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. We offer 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. We are proud of our recognition from local and national organizations regarding our culture and workplace. We are a remote-first organization and offer remote work in approved states.

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