Description
Who We Are
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 . 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 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.
We are proud of the recognition we have received from local and national
organization regarding our culture and workplace:
Role Snapshot
The Policy Development Coordinator will conduct research, collaborate with
Medical Directors, communicate with provider community and assist with
maintaining up to date published Medicare coverage guidelines. This includes:
Initiate, coordinate, and maintain healthcare policy development for
Medicare program.
Respond to Centers for Medicare & Medicaid Services (CMS) mandates from
federal government as they relate to healthcare and policy.
Assist contractor Medical Director in development of healthcare policies.
Serve as a resource to various internal departments, including Customer
Service and Medical Review regarding company Medicare policies.
Update and maintain knowledge of current medical practices related to Medicare
Coverage.
Communicate with external providers and Contractor Advisory Committee
(CAC) to help define CMS requests.
Communicate policy changes externally through correspondence in partnership
with Provider Outreach Education (POE) and customer service activities.
How do I know this opportunity is right for me? If you:
Are looking to move away from direct patient care and want to use your nursing
knowledge in a new and different way
Desire daytime shift hours with no on-call work, limited weekend work, and
paid holidays off
Have an analytical mindset and enjoy taking a deep dive into data and
researching best practices
Possess excellent written and verbal communications skillsets
Are interested in performing work independently while still being part of a
larger team
What will I gain from this role?
Develop a deeper understanding of the Medicare Program
Having your voice heard and making an impact in the Medicare world
Assisting with development, maintaining, and researching Medicare Coverage
that protects the Medicare Trust Fund while providing services medically
necessary to beneficiaries.
Working in a continuous performance feedback environment.
Minimum Qualifications
Bachelor's Degree in related field or equivalent post high school and/or
related work experience
Active RN license, applicable to state of practice
Preferred Qualifications
Bachelor's Degree in Nursing
2 or more years of similar work experience (previous utilization review)
Strong ability to perform independent research on policy items
Salary Range
$74,000 to $79,000
The base pay offered for this position may vary within the posted range based
on your job-related knowledge, skills and experience.
Work Location
This role is open to remote work for this opportunity in the following
approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois,
Indiana, Iowa Michigan, Minnesota, Missouri, Nebraska, Nevada,
New Jersey, North Carolina, North Dakota, Ohio, South Carolina,
South Dakota, T
Remote Work Requirements
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection
(can be checked at )
Please review for additional information
Benefits
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 insurance, dental insurance, and telehealth services start DAY 1
Employee Resource Groups
Professional and Leadership Development Programs
Review additional benefits
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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