JOB REQUIREMENTS: Description 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 Medical Director will work on the
Medical Management team in our WPS Health Insurance line of business.
This role will oversee the process to ensure the appropriateness and
quality of medical care provided to our members. In addition, the
Medical Director will actively use their medical background, experience,
and judgement, with available evidence-based sources make determinations
whether requested services, requested level of care, and/or requested
site of service should be authorized. The Medical Management
department's overall purpose is to improve the health of the
individuals we serve by offering efficient, high-quality,
customer-centric medical management services that will also lower the
cost of the claims. WPS designed the Integrated Care Management (ICM)
Program to demonstrate accountability to the Plan's customers and
employer groups, through active monitoring and managing of healthcare
resources across the full continuum of care. Specific position
responsibilities will include: Participate collaboratively with the
Sales Team for on-site visits to potential group clients, for
presentations regarding Requests for Proposals (RFP) as well as group
renewals Perform pre, post, and concurrent utilization review
determinations. Support policy development using evidence-based
criteria. Work with Medical Coder to review new CPT and HCPS code as
they are released For full info follow application link. Wisconsin
Physicians Service Insurance Corporation is an Equal Opportunity
Employer/Protected Veterans/Individuals with Disabilities employer.
APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/994BF19E519E4E40 Qualified females, minorities, and special
disabled veterans and other veterans are encouraged to apply.
