Professional, Prospective Review RN

Professional, Prospective Review RN

625 State St, Schenectady, NY 12305, USA Req #2141

Tuesday, November 12, 2024

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement.

To achieve this, we're looking for a Prospective Review RN to join #TeamMVP. If you have a passion for patient advocacy, improving quality of care and collaboration, this is the opportunity for you.

What's in it for you :

• 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 and one of the Best Companies to Work For in New York

Qualifications you'll bring :

• Current New York State Licensure as a Registered Nurse required with at least1-3 years of clinical experience required.
• Able to manage multiple tasks in a fast-paced environment.
• Independent thought process; oriented toward problem solving;
• Strong interpersonal and communication skills.
• Excellent computer skills
• 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

Your key responsibilities :

• Performs review of Durable Medical Equipment, Out of Network Reviews, and related services for medical necessity.
• Applies established Medicare Guidelines or Benefit Interpretation criteria and standards.
• Responsible for collecting and interpreting medical information for appropriateness of care.
• Communicates determinations to all parties involved, verbally and in writing, including scope of authorization.
• Facilitates deployment of services and conducts prospective review of all services when necessary.
• Review's problem and complex cases with leaders and communicates effectively with Senior Medical Leaders, physicians, individual providers, and other departments for ongoing coordination of services, including hospital discharges.
• Knows and interprets the MVP contracts, riders, policies, and procedures.
• Complies cost savings reports, attends in-services and interdepartmental meetings.
• Develops and maintains positive relationships with physicians, facilities, and vendors.
• Identifies trends, new technology and policy needs.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where you'll be :

Virtual in Schenectady, NY

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.

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 Veteran or other legally protected classifications.

To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process.

If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected] .

Other details

• Job Family Medical Management / Clinical
• Pay Type Salary
• Min Hiring Rate $56,200.00
• Max Hiring Rate $86,250.00

Apply Now

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625 State St, Schenectady, NY 12305, USA

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