Professional, Prospective Review RN

MVP Service

Schenectady, New York(remote)

JOB DETAILS
SKILLS
Analysis Skills, Best Practices, Clinical Assessment, Clinical Medicine, Clinical Practices/Protocols, Clinical Study Publications, Communication Skills, Compensation and Benefits, Computer Skills, Computer Software, Computer Systems, Data Entry, Diversity, Documentation, Healthcare, Healthcare Providers, Hospital/Healthcare Construction, Industry Standards, Maintain Compliance, Medical Protocols, Medical Records, Medical Terminology, Medical Treatment, Multitasking, Presentation/Verbal Skills, Process Improvement, Registered Nurse (RN), Regulations, Safety/Work Safety, Treatment Plan, Writing Skills
LOCATION
Schenectady, New York
POSTED
12 days ago

Join Us in Shaping the Future of Health Care

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 in the NY Capital District, one of the Best Companies to Work For in New York, 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 Prospective Review Registered Nurse, you will be responsible for evaluating medical requests, treatment plans, and high-cost services to ensure alignment with clinical guidelines and medical necessity standards. This role involves close collaboration with Medical Directors and healthcare providers to support accurate, evidence-based decision-making and promote high-quality patient outcomes across multiple lines of business.
Qualifications you’ll bring: 
  • Current RN (NY or VT)
  • Minimum of 3-5 years clinical experience required
  • 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 complex 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.

Your key responsibilities:  

  • 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 within regulatory timeframes.
  • Communicate with healthcare providers and members to collect pertinent information, discuss review outcomes and provide appropriate referrals within 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. 

Where you'll be:

Location: Remote

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. 

$69,383.00-$92,279.00

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 

hr@mvphealthcare.com

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About the Company

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MVP Service