Concurrent Review - RN

MVP Health Care • Schenectady, NY

1d • $69,383 - $92,279 • Hybrid

About The Position

As a Professional Concurrent Review RN, you’ll have the opportunity to apply your nursing knowledge in a meaningful way—helping ensure members receive the right care at the right time while navigating the healthcare continuum. This role offers a balance of autonomy and collaboration, allowing you to work independently in a hybrid setting while partnering with providers and clinical leadership. You’ll be part of an organization that values clinical judgment, critical thinking, and continuous improvement, empowering you to make an impact beyond bedside care. Ideal for experienced RNs looking to expand into utilization management, this position provides exposure to complex clinical decision-making, healthcare policy interpretation, and care coordination strategies. With opportunities for professional growth, skill development, and potential travel for engagement and learning, this role is designed for nurses seeking both flexibility and career advancement. If you’re detail-oriented, driven by problem-solving, and passionate about improving patient care on a broader scale, this is an excellent opportunity to take your nursing career in a new direction.

Requirements

• RN with current state licensure.
• 3+ years strong clinical background required
• Excellent verbal and written communication abilities.
• Independent thought process; oriented toward probing/problem solving

Nice To Haves

• BS in Nursing or Health Management is preferred.

Responsibilities

• Reviews inpatient medical records against established criteria and standards to determine medical appropriateness and level of care assignment.
• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level