Professional, Sub-Acute RN UM Reviewer - Medicare

MVP Health Care; Village of Tarrytown (NY); Remote; USD 60,000 - 80,000; Full time

Job summary

A health care organization is seeking a Professional, Sub-Acute RN UM Reviewer to join their team. This remote role in New York requires a passion for patient advocacy and experience in utilization management within sub-acute care. Ideal candidates will have RN licensure, significant nursing and Medicare review experience, and strong communication skills. Competitive compensation and growth opportunities are offered.

Benefits

Growth opportunities

Competitive compensation and benefits

Inclusive workplace culture

Qualifications

• Current and unrestricted NY & VT RN licensure.
• Minimum 3 years of clinical nursing experience.
• At least 2 years of experience in utilization management of sub-acute Medicare reviews.

Responsibilities

• Conduct timely and accurate utilization reviews for sub-acute Medicare cases.
• Evaluate medical necessity and appropriateness of services based on established criteria.
• Collaborate with providers and interdisciplinary teams to ensure optimal patient care.

Skills

Patient-centered advocacy

Clinical precision

Regulatory compliance

Excellent communication

Critical thinking

Organizational skills

Curiosity for innovation

Humility in team collaboration

Education

Associate or bachelor's degree in nursing (BSN preferred)

Tools

Electronic medical record (EMR) systems

Utilization management platforms

Job description

Overview

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 Professional, Sub-Acute RN UM Reviewer – Medicare to join #TeamMVP. If you have a passion for patient-centered advocacy, clinical precision and regulatory compliance this is an 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 in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.

Qualifications you’ll bring

• 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
• Experience with Medicare guidelines and documentation standards preferred
• 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 needs
• Excellent communication, critical thinking, and organizational skills.
• Experience with electronic medical record (EMR) systems and UM platforms.
• Familiarity with CMS regulations and appeals processes.
• Ability to work independently and manage multiple priorities.
• 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

• 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.
• Other duties as assigned by leadership.
• 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

MVP Health Care is 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. 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 current or historical salary information from candidates.

MVP’s Inclusion Statement

At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make 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, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, 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.

Application process

To support a safe, drug-free workplace, pre-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 Talent team at [e-mail].