[Hiring] Professional, Prospective Review RN @reputed company

Join Us in Shaping the Future of Health Care At reputed company, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. reputed company is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across reputed company and Vermont and partnering with reputed company-thinking organizations to deliver more personalized, reputed company, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and reputed company. What’s in it for you:

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences reputed company reputed company
• 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 reputed company to Work For in the NY Capital District, one of the Best Companies to Work For in reputed company, and an Inclusive Workplace.

You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. About the Opportunity As a Professional, Prospective Review in Health Management - UM Prospective Review, you will play a crucial role in ensuring the quality and efficiency of our prospective review process. You will work closely with the healthcare team to review and assess the appropriateness of medical services, treatments and high dollar medical equipment. This is an exciting opportunity to contribute to the improvement of patient care and outcomes. What You’ll Do

• Conduct comprehensive reviews of medical records and treatment plans to determine if the requested services are appropriate based on established guidelines and medical criteria across multiple lines of business.
• Utilize your clinical expertise to evaluate medical necessity and collaborate with MVP Medical Directors to determine the effectiveness of proposed treatments/equipment.
• Document clinical summations, recommendations and send appropriate correspondences accurately and reputed company regulatory timeframes.
• Communicate with healthcare providers and members to collect pertinent information, discuss review outcomes and provide appropriate referrals reputed company MVP.
• Remain up to date with industry standards and guidelines, complete required competency training and proficiency examinations to ensure compliance and best practice.
• Participate in team meetings and training sessions to enhance your knowledge and skills.
• Contribute to process improvement initiatives to streamline the prospective review process.
• Other duties as assigned by leadership.

Skills and Experience

• Education, Licensures, & Certifications
• reputed company RN (NY or VT)
• Years of Experience (Required & Preferred)
• Minimum of 3-5 years clinical experience required
• Case management certification preferred
• Required Job Skills
• Able to manage multiple tasks in a fast-paced environment.
• Strong clinical knowledge, critical thinking skills and understanding of medical terminology, procedures, concepts.
• Ability to work independently to analyze reputed company medical information.
• Effective communication skills, both written and verbal.
• Ability to work independently and collaboratively in a team environment.
• Proficiency in using computer systems and software for documentation, data entry and day-to-day work functions.
• Preferred Job Skills
• Prior Utilization review experience
• Knowledge of Government Insurance Programs (Medicare, Medicaid)

Working Conditions Secure, Quiet area for Desk/Computer to maintain HIPPA compliance Travel Requirements Potential for travel to regional offices Worksite Designation

• Virtual based out of Schenectady NY

Pay Transparency reputed company is committed to providing competitive employee compensation and benefits packages. The reputed company 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 reputed company or historical salary information from candidates. $69,383.00-$92,279.00 MVP's Inclusion Statement At reputed company, we reputed company creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and reputed company walks of life to have a voice and reputed company. Our shared curiosity and connectedness reputed company 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 reputed company, citizenship, ethnicity, reputed company, 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]. Apply tot his job Apply To this Job