MVP Health Care
1001 - 5000 employees
Founded 1983
⚕️ Healthcare Insurance
👥 B2C
🤝 B2B
Healthcare Insurance • B2C • B2B
MVP Health Care is a regional health insurer offering Medicare Advantage, Medicaid, individual and family plans, Child Health Plus, Essential Plans, and employer-sponsored group coverage. The company provides dental and vision add-on plans, prescription benefits, 24/7 virtual care through its Gia online portal, member services for billing and claims, and community wellness programs focused on affordable, accessible coverage in New York and nearby regions.
Sub-Acute RN UM Reviewer – Medicare
🕒 June 2
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MVP Health Care
1001 - 5000 employees
Founded 1983
⚕️ Healthcare Insurance
👥 B2C
🤝 B2B
Healthcare Insurance • B2C • B2B
MVP Health Care is a regional health insurer offering Medicare Advantage, Medicaid, individual and family plans, Child Health Plus, Essential Plans, and employer-sponsored group coverage. The company provides dental and vision add-on plans, prescription benefits, 24/7 virtual care through its Gia online portal, member services for billing and claims, and community wellness programs focused on affordable, accessible coverage in New York and nearby regions.
📋 Description
• 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.
🎯 Requirements
• 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.
🏖️ 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
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