Military Spouse Connection Jobs

JOB REQUIREMENTS: Description Who We Are WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in 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 Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready. Culture Drives Our Success 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 and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. From 2021 to 2023, WPS Health Solutions was recognized for several awards: Madison, Wisconsin\'s Top Workplaces USA Top Workplaces and the cultural excellence awards for Remote Work and Work-Life Flexibility Achievers 50 Most Engaged Workplaces with the further honor of Achievers \"Elite 8\" winner in the category of Culture Alignment DAV Patriot Employer VETS Indexes 4 Star Employer BBB Torch Award for Ethics from Better Business Bureau of Wisconsin 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: Provide in depth training on Prior Authorization topics to Facility Providers including MD\'s and requesters 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... For full info follow application link. Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/7D9DB8E4081446BF Qualified females, minorities, and special disabled veterans and other veterans are encouraged to apply.