Policy Nurse Analyst

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.

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

• 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.

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

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
•  Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are
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.

Culture Drives Our Success
WPS’ culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace:  WPS Newsroom - Awards and Recognition.

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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s).  As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services