Professional, Retrospective Review
2 weeks ago
625 State St, Schenectady, NY 12305, USA • Rochester, NY, USA • Tarrytown, NY, USA Req #2266
Friday, October 25, 2024
At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Retrospective Review-RN to join #TeamMVP. If you have a passion for problem solving, interdisciplinary collaboration and patient advocacy, this is the opportunity for you.
What's in it for you:
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York
Qualifications you'll bring:
- Current NYS RN license with 3+ years strong clinical background required
- Knowledgeable in ICD-10 Diagnoses and Procedural Coding Guidelines
- Ability to perform critical audits of medical records applying coding guidelines and
clinical picture to validate code assignment - Proven success with interacting with providers on delicate matters of medical
necessity and service appropriateness. - Curiosity to foster innovation and pave the way for growth
- Humility to play as a team
- Commitment to being the difference for our customers in every interaction
Your key responsibilities:
- Performs Retrospective Review for inpatient admissions and outpatient services which includes claim review for all regions.
- Completes Retrospective Review for medical necessity and appropriateness of care as based on predetermined criteria and/or guidelines.
- Knows and interprets MVP contracts, policies and procedures and InterQual Criteria.
- Discuss complex cases with the Leaders and Medical Directors.
- Assists with the coordination of the monthly UM retrospective reports.
- Research, coordinates, and completes special projects for the Leader.
- Recommends revisions in the UM process to ensure the maximum level of automation, efficient time utilization and data quality.
- Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.
Where you'll be:
Virtual in NYS
Pay Transparency
At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
Affirmative Action
MVP is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at hr@mvphealthcare.com .
Other details
- Job Family Medical Management/Clinical
- Pay Type Salary
- Min Hiring Rate $56,200.00
- Max Hiring Rate $92,000.00
-
Pharmacist Professional Clinical
3 weeks ago
Schenectady, New York, United States MVP Health Care Full timeJob Title: Professional Clinical PharmacistWe are seeking a highly skilled and experienced Professional Clinical Pharmacist to join our team at MVP Health Care. As a key member of our pharmacy team, you will play a critical role in providing exceptional patient care and contributing to the development of innovative healthcare solutions.Key...
-
Pharmacy, Professional, Clinical Pharmacist
4 weeks ago
Schenectady, United States MVP Health Care Full timePharmacy, Professional, Clinical PharmacistFishkill Office, 300 Westage Business Center Drive, Fishkill, New York, United States of America • Headquarters Office, 625 State Street, Schenectady, New York, United States of America • Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America • Tarrytown Office, 303 South Broadway,...
-
Medical Professional
3 weeks ago
Schenectady, New York, United States Community Care Physicians Full timePulmonary Medicine OpportunityWe are seeking a skilled Medical Professional to join our team in Pulmonary Medicine. This is a full-time position, Monday - Friday, 8:30 am to 4:30 pm.ResponsibilitiesPractice medicine with physician supervision, including conducting examinations and writing prescriptions.Collaborate with physicians in managing acute and...
-
Audit Professional
2 weeks ago
Schenectady, New York, United States Dannible and McKee, LLP Full timeJob OpportunityDannible & McKee, LLP is seeking a highly motivated individual to join our audit team as an intern. As a member of our team, you will have the opportunity to develop and expand your technical knowledge while working under the supervision of experienced professionals.Key Responsibilities:Assist engagement teams on audits, reviews, and...
-
Senior Software Engineer
2 weeks ago
Schenectady, New York, United States MVP Health Care Full timeAbout the RoleWe are seeking a highly skilled Senior Software Engineer to join our team at MVP Health Care. As a key member of our production support team, you will be responsible for resolving complex technical issues across our digital platforms.Key ResponsibilitiesResolving production support issues across multiple digital platformsParticipating in...
-
Senior Software Engineer
4 weeks ago
Schenectady, New York, United States MVP Health Care Full timeAbout the RoleWe are seeking a highly skilled Senior Software Engineer to join our Sitecore development team. As a key member of our team, you will be responsible for designing, developing, and deploying high-quality Sitecore web solutions.Key ResponsibilitiesPlay a key role as a Scrum/Agile team member in the design, development, deployment, and support of...
-
Senior Software Engineer
4 weeks ago
Schenectady, United States MVP Health Care Full timeSenior Software EngineerHeadquarters Office, 625 State Street, Schenectady, New York, United States of America • Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America • Tarrytown Office, 303 South Broadway, Tarrytown, New York, United States of America • Virtual Req #2228Tuesday, October 8, 2024At MVP Health Care, we're on...
-
Professional, Facility Contractor Specialist
4 weeks ago
Schenectady, New York, United States MVP Health Care Full timeJob Title: Professional, Facility ContractorWe are seeking a highly skilled and experienced Professional, Facility Contractor to join our team at MVP Health Care. As a key member of our operations team, you will be responsible for coordinating with our analytics team to generate performance reporting and associated financial models.Key...
-
Professional Case Manager
1 week ago
Schenectady, New York, United States MVP Health Care Full timeJob Summary:This position will utilize the essentials of an integrated Case Management model that includes assessment, planning, implementation, care coordination, monitoring, and advocacy to meet the member's comprehensive health needs. Through collaborative efforts, the Case Manager will identify the medical and psycho-social needs of designated members,...
-
Professional Customer Services Representative
1 month ago
Schenectady, United States Appolo Heating Full timeAppolo Heating is a leading home services provider seeking a personable, reliable individual to serve as a Customer Service Representative/Dispatcher to join our growing company Are you interested in taking your career to the next level with an industry leader? You will handle inbound and outbound customer service calls from an established customer base as...
-
Medical Assistant Professional
1 month ago
Schenectady, New York, United States OrthoNY Full timeJob OverviewOrthoNY is seeking a skilled Medical Assistant to provide exceptional patient care and support to our dedicated team of physicians.Key Responsibilities:Assist patients with registration, demographic data collection, and medical history documentation.Prepare patients for exams by performing preliminary tests and reporting relevant information to...
-
Dental Assistant Professional
2 weeks ago
Schenectady, New York, United States 1st Advantage Dental - Niskayuna - Balltown Full timeAbout the RoleWe are seeking a highly skilled and motivated Dental Assistant to join our team at 1st Advantage Dental - Niskayuna - Balltown. As a key member of our dental team, you will be responsible for providing exceptional patient care and support to our dentists and hygienists.Key ResponsibilitiesProvide chairside assistance to dentists during various...
-
Procurement Business Professional Intern
7 days ago
Schenectady, New York, United States Bechtel Plant Machinery Full timeJob SummaryAs a Procurement Business Professional Intern at Bechtel Plant Machinery, Inc., you will be responsible for performing contract functions which provide for budgeting, negotiation, placement, administration, and close out of contracts in accordance with company policies, legal requirements, and Government specifications.Key ResponsibilitiesPrepare...
-
Medicare Claims Processing Professional
2 weeks ago
Schenectady, New York, United States MVP Health Care Full timeJob SummaryMVP Health Care is seeking a skilled Claims Processing Professional to join our Operations Claims team. As a key member of our team, you will develop solutions leveraging claims automation and system enhancements to enable faster, more accurate execution of repetitive tasks in production environments.Key ResponsibilitiesCollaborate with the RPA...
-
Professional Case Manager
2 weeks ago
Schenectady, New York, United States MVP Health Care Full timeAbout the RoleMVP Health Care is seeking a highly skilled and dedicated Case Manager to join our team. As a key member of our medical management team, you will play a critical role in ensuring the highest quality of care for our members.Key ResponsibilitiesUtilize an integrated Case Management model to assess, plan, implement, and monitor care coordination...
-
Night Auditor
2 weeks ago
Schenectady, New York, United States Doubletree Schenectady, NY Full timeHotel Night Auditor Job DescriptionAt Doubletree Schenectady of Schahet Hotels, we are seeking a skilled Night Auditor to join our team. As a Night Auditor, you will be responsible for attending to guests' needs, including registration, checkout, and cashiering. You will also be responsible for reviewing all guaranteed arrivals and verifying that all credit...
-
Schenectady, New York, United States Schenectady ARC Full timeSchenectady ARC is committed to providing high-quality services to developmentally disabled adults. We are seeking a skilled Licensed Practical Nurse (LPN) to join our team at Ridge Health Services, our onsite clinic.The LPN will provide nursing tasks within the scope of practice for an LPN with RN oversight, ensuring accurate documentation on each patient's...
-
Professional, Case Manager
3 months ago
Schenectady, United States MVP Health Care Full timeJob DescriptionProfessional, Case ManagerHeadquarters Office, 625 State Street, Schenectady, New York, United States of America Req #2121Wednesday, August 7, 2024Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for...
-
Professional, Case Manager
3 months ago
Schenectady, United States MVP Health Care Full timeProfessional, Case ManagerHeadquarters Office, 625 State Street, Schenectady, New York, United States of America Req #2121Wednesday, August 7, 2024Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The...
-
Cardiology Office Nursing Professional
3 days ago
Schenectady, New York, United States Trinity Health Full timeAt Trinity Health, our mission is to provide high-quality, patient-centered care to the communities we serve. As a Cardiology Office Nursing Professional with our Glenville, NY team, you will play a vital role in delivering exceptional care to our patients.Job SummaryWe are seeking a skilled and compassionate LPN to join our team in Glenville, NY. As an LPN,...