[Remote] Sub-Acute RN UM Reviewer - Medicare

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.ResponsibilitiesConduct timely and accurate utilization reviews for sub-acute Medicare casesEvaluate medical necessity, level of care, and appropriateness of services based on established criteria and guidelinesSupport and assess discharge planning efforts to ensure continuity of care and appropriate post-acute servicesCollaborate with providers, facilities, and interdisciplinary teams to ensure optimal patient care and resource utilizationDocument review outcomes and maintain compliance with regulatory and organizational standardsParticipate in audits, quality improvement initiatives, and training sessionsMaintain current knowledge of Medicare regulations and UM best practicesSkillsCurrent and unrestricted NY & VT RN licensureAssociate or bachelor's degree in nursing (BSN preferred)Minimum 3 years of clinical nursing experienceAt least 2 years of experience in utilization management of sub-acute Medicare reviewsStrong knowledge of sub-acute care, rehabilitation, and skilled nursing servicesProficiency in interpreting medical records and applying medical necessity criteriaUnderstanding of discharge planning process and transitional care needExcellent communication, critical thinking, and organizational skillsBachelor's degree in nursing (BSN preferred)BenefitsGrowth opportunities to uplevel your careerA people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our teamCompetitive compensation and comprehensive benefits focused on well-beingAn 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 OverviewMVP 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.