WPS—A health solutions company
Policy Nurse Analyst
Company Description
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Job Description
Our Policy Nurse Analyst supports the development and maintenance of Medicare healthcare policies by conducting research, collaborating with Medical Directors, and engaging with both internal teams and external provider communities. They ensure that published Medicare coverage guidelines remain current, evidence-based, and compliant with federal regulations. This Policy Nurse Analyst plays a key role in interpreting CMS mandates, synthesizing clinical evidence, and contributing to the continuous improvement of the policy development process. Salary Range 70,000 ~ $85,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin Employees living within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI) will be expected to be able to work in the office 2 days a week on a regular basis.
Requirements
Minimum Qualifications: Bachelor’s Degree in Nursing (BSN) or equivalent combination of education and experience. Active Registered Nurse (RN) license in state of practice or a compact nursing license. 2 or more years of experience in healthcare, health policy, clinical research, or a related field; including familiarity with regulatory standards (i.e., CMS, Medicare, URAC). Knowledge of medical coding (e.g., ICD-10, CPT, HCPCS); Proven experience conducting research, analyzing information, and summarizing findings. Strong critical thinking, ability to work independently applying sound nursing judgement, creative problem solving, and clinical decision-making skills. Strong organizational skills with the ability to meet deadlines, manage competing priorities, and maintain quality standards. Strong written and verbal communication skills with the ability to communicate complex medical information clearly and concisely. Proficiency in Microsoft Office tools (outlook, Word, Excel, One-Note) and shared document environments. Preferred Qualifications: Certification in medical coding. Experience evaluating medical literature GRADE Methodology. A passion for research and investigating. 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 (can be checked at https://speedtest.net) Please review Remote Worker FAQs for additional information
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Responsibilities
Can initiate, coordinate, and maintain healthcare policy development for the Medicare programs. Have responded to mandates from the Centers for Medicare & Medicaid Services (CMS) and ensure alignment with federal healthcare policy requirements. Enjoy assisting Contractor Medical Directors in the development and revision of healthcare policies. Would like to serve as a resource to internal departments, including Customer Service and Medical Review, regarding Medicare policies. Can maintain up-to-date knowledge of current medical practices and Medicare coverage guidelines. Enjoy communicating with external providers and the Contractor Advisory Committee (CAC) to support clarification and implementation of CMS requests. Thrive when conducting research to determine safety and efficacy of healthcare products and procedures and producing clear written summaries of clinical evidence. Like to collaborate with multidisciplinary teams to draft, review, and revise medical policies. Can support continuous improvement initiatives within the medical policy development process.
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