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Policy Nurse Analyst
WPS—A health solutions company
- New York, New York, United States
- New York, New York, United States
Über
Our Policy Nurse Analyst supports the development and maintenance of Medicare healthcare policies by conducting research, collaborating with Medical Directors, and engaging with internal teams and external provider communities. They ensure that published Medicare coverage guidelines remain current, evidence-based, and compliant with federal regulations. This role interprets CMS mandates, synthesizes clinical evidence, and contributes to the continuous improvement of the policy development process. Responsibilities
Initiate, coordinate, and maintain healthcare policy development for the Medicare programs. Respond to mandates from the Centers for Medicare & Medicaid Services (CMS) and ensure alignment with federal healthcare policy requirements. Assist Contractor Medical Directors in the development and revision of healthcare policies. Serve as a resource to internal departments, including Customer Service and Medical Review, regarding Medicare policies. Maintain up-to-date knowledge of current medical practices and Medicare coverage guidelines. Communicate with external providers and the Contractor Advisory Committee (CAC) to support clarification and implementation of CMS requests. Conduct research to determine safety and efficacy of healthcare products and procedures and produce clear written summaries of clinical evidence. Collaborate with multidisciplinary teams to draft, review, and revise medical policies. 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 judgment, 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, OneNote) and shared document environments. Preferred Qualifications
Certification in medical coding. Experience evaluating medical literature using GRADE methodology. A passion for research and investigation. Remote Work Requirements
Wired (ethernet) 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 (check at speedtest.net). 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 salary and a 50% match for the next 2% (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:
(no links here). About Us
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. Compliance: 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 before being granted access to information systems and sensitive data.
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Sprachkenntnisse
- English
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