Sub-Acute RN UM Reviewer - Medicare

MVP Health Care • US NY Remote, NY

2d • $69,383 - $92,279 • Remote

About The Position

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.

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.

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.

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
• Education Level: Associate degree