UM Concurrent Review, Professional, Concurrent Review - RN #906
Status: Full-time, Exempt: Yes
This position tracks and influences the services provided to MVP members as they move through the continuum of care. Duties may include: Reviews inpatient medical records against established criteria and standards to determine medical appropriateness and level of care assignment. May review individual claims requiring clinical interpretation and judgment. Implements the operational functions of the MVP Utilization Management program as assigned. Potential to travel to designated locations to access medical information. Tracks on a regular basis the required care of individual members and advises providers of desired delivery options such as equipment vendors and home care agents. Collects and reviews care plans and progress reports to justify extension of service authorization. Reviews complex cases with individual providers or leader and the MVP Senior Medical Leaders. Knows and interprets the MVP contract, riders, policies and procedures. Perform other duties as assigned.
This position can be worked remotely/virtually from within New York or Vermont with the potential to travel.
RN with current state licensure
BS in Nursing or Health Management is preferred.
3+ years strong clinical background required
Minimum of 1 year UM experience is preferred
Familiarity with National Criteria Standards is preferred
• Excellent verbal and written communication abilities;
• Independent thought process; oriented toward probing/problem solving
• Working computer knowledge
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the EEO is the Law Poster and Supplement protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at email@example.com