Leader, Concurrent Review

MVP Health Care • Tarrytown, NY

97d

About The Position

This position involves supervising and supporting RN staff performing Utilization Management (UM) reviews. The role requires ensuring timely, accurate, and compliant review of medical necessity and level of care, as well as monitoring and guiding discharge planning efforts to ensure safe and appropriate transitions of care. The individual will provide coaching, feedback, and performance evaluations for team members, serve as a clinical resource for complex cases, and collaborate with interdisciplinary teams to resolve care coordination issues. Additionally, the role includes ensuring documentation meets regulatory and organizational standards, participating in audits and quality improvement initiatives, and contributing to various responsibilities that enhance healthcare delivery.

Requirements

• Current and unrestricted NY, VT RN license.
• Associate or bachelor's degree in nursing (BSN preferred).
• Minimum 4 years of clinical nursing experience.
• At least 2 years in utilization management sub-acute care review.
• 2+ years of supervisory experience.
• Strong understanding of concurrent review, sub-acute care, rehabilitation, and skilled nursing services.
• Knowledge of discharge planning processes and transitional care coordination.
• Ability to lead and motivate clinical teams.
• Proficiency in applying clinical criteria and interpreting medical records.
• Experience with EMR systems and UM platforms.
• Familiarity with CMS regulations and appeals processes.
• Strong communication, conflict resolution, and organizational skills.

Nice To Haves

• Curiosity to foster innovation and pave the way for growth.
• Humility to play as a team.
• Commitment to being the difference for our customers in every interaction.

Responsibilities

• Supervise and support RN staff performing UM reviews.
• Ensure timely, accurate, and compliant review of medical necessity and level of care.
• Monitor and guide discharge planning efforts to ensure safe and appropriate transitions of care.
• Provide coaching, feedback, and performance evaluations for team members.
• Serve as a clinical resource and escalation point for complex cases.
• Collaborate with interdisciplinary teams, providers, and facilities to resolve care coordination issues.
• Ensure documentation meets regulatory and organizational standards.
• Participate in audits, quality improvement initiatives, and training programs.
• Perform other duties as assigned by leadership.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree