Note: The job is a remote job and is open to candidates in USA. MVP Health Care is on a mission to create a healthier future for everyone. As a Sub-Acute RN UM Reviewer-Medicare, you will conduct clinical reviews to ensure appropriate use of healthcare services, maintaining compliance with Medicare guidelines and supporting high-quality patient outcomes.
Responsibilities
- Conduct timely and accurate utilization reviews for sub-acute Medicare cases
- Evaluate medical necessity, level of care, and appropriateness of services based on established criteria and guidelines
- Support and assess discharge planning efforts to ensure continuity of care and appropriate post-acute services
- Collaborate with providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization
- Document review outcomes and maintain compliance with regulatory and organizational standards
- Participate in audits, quality improvement initiatives, and training sessions
- Maintain current knowledge of Medicare regulations and UM best practices
Skills
- Current and unrestricted NY & VT RN licensure
- Associate or bachelor's degree in nursing (BSN preferred)
- Minimum 3 years of clinical nursing experience
- At least 2 years of experience in utilization management of sub-acute Medicare reviews
- Strong knowledge of sub-acute care, rehabilitation, and skilled nursing services
- Proficiency in interpreting medical records and applying medical necessity criteria
- Understanding of discharge planning process and transitional care need
- Excellent communication, critical thinking, and organizational skills
- Bachelor's degree in nursing (BSN preferred)
Benefits
- 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 in the NY Capital District**, one of **the Best Companies to Work For in New York**, and an **Inclusive Workplace**.
Company Overview
MVP Health Care is a health care insurance provider for individuals, families, and companies. It was founded in 1982, and is headquartered in Schenectady, New York, USA, with a workforce of 1001-5000 employees. Its website is https://www.mvphealthcare.com.