Sub-Acute RN UM Reviewer - Medicare

About the role

As a Sub-Acute RN UM Reviewer-Medicare, you will play a vital role in our Utilization Management team by conducting clinical reviews to ensure appropriate use of healthcare services. This position is essential for maintaining compliance with Medicare guidelines and supporting high-quality patient outcomes. The ideal candidate will bring strong clinical judgment, experience in sub-acute care settings, and a commitment to improving healthcare delivery through effective collaboration and discharge planning. 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 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. 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. Where you'll be: Location: Remote 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. $69,383.00-$92,279.00 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