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Senior Medical Review Nurse Analyst (RN) at WPS Health Solutions

Posted in Other 30+ days ago.

Location: Phoenix, Arizona

Job Description:


Who We Are

WPS Health Solutions is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service 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. In 2021, WPS Health Solutions celebrates 75 years of making health insurance easier for those we serve. Proud to be military and veteran ready.

Our Culture

WPS' Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. 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 guided by our Purpose: Together, making health care easier for the people we serve.

In 2021, WPS Health Solutions was recognized for several awards including:

Role Snapshot

Our Senior Medical Review Nurse Analyst position is a work from home position and serves as a subject matter expert (SME) to clinical staff regarding Medicare regulations to ensure accurate and timely claim processing. Additional details:

  • Plan and facilitate training events on general topics and department specific processes for large groups, small groups and individuals.

  • Provide on the floor performance support after training, and document completed training activities.

  • Develop and update written work instructions.

  • Review and recommend policy changes when appropriate and update training materials in response to Centers for Medicare and Medicaid Services (CMS) regulatory changes and/or changes in Local Coverage Determinations.

  • Perform post training quality analysis reviews and determine when a trainee can be released based on post training assessment.

  • Participate in and assist with development of provider education and training activities.

  • Evaluate and report employee progress and training feedback to business unit leads within defined Service Level Agreements when assisting with training.

  • Develop, implement, and perform quality assurance activities, record scores in NICE (Employee Engagement Manager tool), and monitor results.

  • Collaborate with business units, contract medical directors, and subject matter experts on new CMS issued directives.

How do I know this opportunity is right for me? If you:

  • Desire day hours with no on-call work, limited weekend work, and holidays off

  • Have strong verbal and written communication

  • Enjoy teaching and training providers

  • Are technically strong on computers

  • Are self-motivated and work with a great degree of independence

  • Have the ability to multitask, set priorities and excel at time management

  • Enjoy process improvement

What will I gain from this role?

  • Building your indirect leadership skills

  • Collaborating with other team members that are both clinicians and non-clinicians

  • Staying connected with providers

  • Continuous performance feedback

  • Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries

Minimum Qualifications

  • COVID-19 vaccination or WPS approval for an accommodation.

  • Bachelors Degree in related field or equivalent post high school and/or related work experience

  • Active RN license, applicable to state of practice

Preferred Qualifications

  • 4 or more years of experience in clinical nursing

  • Bachelor's Degree in Nursing

  • Leadership and/or training experience

  • Nurse Analyst experience with background in Medicare principles and guidelines


  • Remote and hybrid work options 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, dental insurance, Teladoc starts DAY 1

  • Review additional benefits here

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The 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 60-1.35(c)
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