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' 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: WPS Newsroom - Awards and Recognition

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, Texas, Virginia, Wisconsin

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 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 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 here

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