RN Utilization Management Reviewer
6 days ago
At MVP Health Care, we are dedicated to building a healthier future for everyone through innovative thinking and continuous improvement. We are currently seeking a RN Utilization Management Reviewer - Medicare who shares our passion for patient-centered advocacy, clinical precision, and regulatory compliance. This is your chance to make a significant impact in the healthcare field.
What we offer you:
- Opportunities for professional growth and career advancement
- A people-centric culture that values diverse perspectives and experiences
- Competitive compensation and comprehensive well-being benefits
- The chance to be part of a team recognized as a Best Place to Work in the NY Capital District and one of the Best Companies to Work For in New York
Essential Qualifications:
- Active and unrestricted RN licensure in NY and VT
- Associate or bachelor’s degree in nursing (BSN preferred)
- Minimum of 3 years of clinical nursing experience
- At least 2 years of experience in utilization management with a focus on sub-acute Medicare reviews
- Familiarity with Medicare guidelines and documentation standards
- Solid understanding of sub-acute care, rehabilitation, and skilled nursing services
- Ability to interpret medical records and apply medical necessity criteria
- Knowledge of discharge planning processes and transitional care needs
- Excellent communication, critical thinking, and organizational skills
- Experience with electronic medical records (EMR) and UM platforms
- Understanding of CMS regulations and appeals processes
- Ability to work independently while managing multiple priorities
- A curious mindset to foster innovation and drive growth
- A team-oriented approach with humility
- A strong commitment to customer care in every interaction
Your Key Responsibilities:
- Perform timely and accurate utilization reviews for Medicare sub-acute cases
- Assess medical necessity, levels of care, and appropriateness of services based on guidelines
- Support discharge planning efforts to ensure appropriate post-acute care
- Collaborate with providers, facilities, and interdisciplinary teams for optimal patient care
- Document review outcomes while maintaining compliance with regulatory standards
- Engage in audits, quality improvement initiatives, and training sessions
- Stay updated on Medicare regulations and best practices in UM
- Fulfill other responsibilities as assigned by management
- Contribute to a culture of excellence by supporting various healthcare delivery initiatives
Work Environment:
This position is virtual and based in NYS.
Pay Transparency:
MVP Health Care is committed to providing competitive compensation and benefits. The base pay range reflects a good faith estimate at the time of posting and may vary based on location, experience, education, and the specifics of the role.
Inclusion Statement:
At MVP Health Care, we believe that healthier communities start with a healthy workplace. We are committed to creating an inclusive environment that values diverse backgrounds and empowers every voice.
MVP is an equal opportunity employer and does not discriminate on any legally protected grounds. Pre-employment criminal background checks and drug testing are parts of our hiring process. Candidates requiring accommodations during the application process due to a disability should reach out to our Talent team.
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