Policy Nurse Analyst

WPS—A health solutions company • Fitchburg, WI

3d • $70,000 - $85,000 • Remote

About The Position

Our Policy Nurse Analyst supports the development and maintenance of Medicare
healthcare policies by conducting research, collaborating with Medical
Directors, and engaging with both 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.

Requirements

• 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 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.

Nice To Haves

• Certification in medical coding.
• Experience evaluating medical literature GRADE Methodology.
• A passion for research and investigating.

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 producing 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.

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 start DAY 1
• Professional and Leadership Development Programs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level