PROFESSIONAL, RETROSPECTIVE REVIEW - RN - MVP Health Care : Job Details

Professional, Retrospective Review - RN625 State St, Schenectady, NY 12305, USA • Rochester, NY, USA • Tarrytown, NY, USA Req #2266Friday, October 25, 2024At 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 Retrospective Review-RN to join #TeamMVP. If you have a passion for problem solving, interdisciplinary collaboration and patient advocacy, 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 NYS RN license with 3+ years strong clinical background required

• Knowledgeable in ICD-10 Diagnoses and Procedural Coding Guidelines
• Ability to perform critical audits of medical records applying coding guidelines and clinical picture to validate code assignment
• Proven success with interacting with providers on delicate matters of medical necessity and service appropriateness.
• 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 Retrospective Review for inpatient admissions and outpatient services which includes claim review for all regions.
• Completes Retrospective Review for medical necessity and appropriateness of care as based on predetermined criteria and/or guidelines.
• Knows and interprets MVP contracts, policies and procedures and InterQual Criteria.
• Discuss complex cases with the Leaders and Medical Directors.
• Assists with the coordination of the monthly UM retrospective reports.
• Research, coordinates, and completes special projects for the Leader.
• Recommends revisions in the UM process to ensure the maximum level of automation, efficient time utilization and data quality.
• 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 NYSPay Transparency At MVP, we are 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. Specific employment offers and associated compensation will be made 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.Affirmative Action MVP is an Affirmative Action/ Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at [email protected] .Other details

• Job Family Medical Management/Clinical
• Pay Type Salary
• Min Hiring Rate $56,200.00
• Max Hiring Rate $92,000.00