Policy Nurse Analyst

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 internal teams and external provider communities. This role ensures published Medicare coverage guidelines remain current, evidence‑based, and compliant with federal regulations. The analyst interprets CMS mandates, synthesizes clinical evidence, and contributes to continuous improvement of the policy development process. Salary Range: $70,000 – $85,000 Work Location: 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, Madison, WI) will be expected to work in the office two days a week. Responsibilities Initiate, coordinate, and maintain healthcare policy development for 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 (e.g., 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 using GRADE Methodology. A passion for research and investigation. 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. 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 starting DAY 1. Professional and Leadership Development Programs. Additional benefits information available at the company website. This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s) and 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. #J-18808-Ljbffr