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.

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