Policy Nurse Analyst

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 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 Work Location: Remote work is available 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, Madison, WI) are expected to work in the office 2 days a week on a regular basis. Fit & Skills Initiate, coordinate, and maintain healthcare policy development for Medicare programs. Responded to mandates from the Centers for Medicare & Medicaid Services (CMS) and ensured alignment with federal healthcare policy requirements. Assisted Contractor Medical Directors in the development and revision of healthcare policies. Served as a resource to internal departments, including Customer Service and Medical Review, regarding Medicare policies. Maintained up‑to‑date knowledge of current medical practices and Medicare coverage guidelines. Communicated with external providers and the Contractor Advisory Committee (CAC) to support clarification and implementation of CMS requests. Conducted research to determine safety and efficacy of healthcare products and procedures and produced clear written summaries of clinical evidence. Collaborated with multidisciplinary teams to draft, review, and revise medical policies. Supported 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; familiarity with regulatory standards (e.g., CMS, Medicare, URAC). Knowledge of medical coding (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, 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 router to computer. High‑speed cable or fiber internet. Minimum 10 Mbps downstream and at least 1 Mbps upstream (speedtest.net). Review Remote Worker FAQs for additional information. Benefits Remote and hybrid work options. Performance bonus and/or merit increase opportunities. 401(k) with 100% match for the first 3 % of salary and 50 % match for the next 2 % (100 % vested immediately). Competitive paid time off. Health, dental, and telehealth insurance starting DAY 1 . Professional and leadership development programs. Review additional benefits on the company website. WPS is a health solutions company and a leading not‑for‑profit health insurer and federal government contractor headquartered in Madison, Wisconsin. It offers health insurance plans for individuals, families, seniors, and group 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 fosters a culture of innovation, empowerment, and inclusion, supporting employee engagement and agile teams. This position supports services under Centers for Medicare & Medicaid Services (CMS) contracts and is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies. Equal Opportunity Employer – Veterans – Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, review the Known Your Rights notice from the Department of Labor. #J-18808-Ljbffr