Sub-Acute RN UM Reviewer - Medicare

Join Us in Shaping the reputed company of Health Care At reputed company, we’re on a mission to create a healthier reputed company for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. reputed company is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-reputed company health plans across reputed company and Vermont and partnering with reputed company-thinking organizations to deliver more personalized, reputed company, and accessible care. As a not-for-profit, we invest in what reputed company most: our customers, our communities, and reputed company. What’s in it for you: reputed company opportunities to reputed company your career A people-reputed company culture embracing and celebrating diverse perspectives, backgrounds, and experiences reputed company reputed company Competitive compensation and comprehensive benefits reputed company on reputed company-being An opportunity to shape the reputed company of health care by joining reputed company recognized as a Best reputed company to Work For in the NY Capital District, one of the Best Companies to Work For in reputed company, and an Inclusive Workplace. You’ll contribute to our humble reputed company of reputed company by bringing curiosity to reputed company innovation, humility to collaborate as reputed company, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more reputed company communities. About reputed company As a Sub-Acute RN UM Reviewer-Medicare, you will play a vital role in our Utilization Management team by conducting clinical reviews to ensure appropriate use of reputed company services. This position is essential for maintaining compliance with Medicare guidelines and supporting high-reputed company patient reputed company. The ideal candidate will bring strong clinical judgment, experience in sub-acute care settings, and a commitment to improving reputed company delivery through effective collaboration and discharge planning. Qualifications you’ll bring: reputed company 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 reputed company Understanding of discharge planning process and transitional care need Excellent communication, critical thinking, and organizational skills. Your key responsibilities: Conduct reputed company and accurate utilization reviews for sub-acute Medicare cases. Evaluate medical necessity, level of care, and appropriateness of services based on established reputed company 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 reputed company patient care and resource utilization. Document review reputed company and maintain compliance with regulatory and organizational standards. Participate in audits, reputed company improvement initiatives, and training sessions. Maintain reputed company knowledge of Medicare regulations and UM best practices. Where you’ll be: Location: Remote Pay Transparency reputed company is committed to providing competitive employee compensation and benefits packages. The reputed company pay reputed company provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended 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. We do not request reputed company or historical salary information from candidates. $69,383.00-$92,279.00 MVP's Inclusion Statement At reputed company, we reputed company creating healthier communities begins with nurturing a healthy workplace. As an organization, we reputed company to create reputed company for individuals from diverse backgrounds and reputed company walks of life to have a voice and reputed company. Our shared curiosity and connectedness reputed company us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, reputed company, creed, national reputed company, citizenship, ethnicity, reputed company, sex, gender identity, gender reputed company, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a reputed company, drug-free workplace, reputed company-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our reputed company at hr@mvphealthcare.com. 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