About the Opportunity As a Professional Concurrent Review RN, you'll have the opportunity to apply your nursing knowledge in a meaningful way-helping ensure members receive the right care at the right time while navigating the healthcare continuum.
This role offers a balance of autonomy and collaboration, allowing you to work independently in a hybrid setting while partnering with providers and clinical leadership. You'll be part of an organization that values clinical judgment, critical thinking, and continuous improvement, empowering you to make an impact beyond bedside care. Ideal for experienced RNs looking to expand into utilization management, this position provides exposure to complex clinical decision-making, healthcare policy interpretation, and care coordination strategies. With opportunities for professional growth, skill development, and potential travel for engagement and learning, this role is designed for nurses seeking both flexibility and career advancement. If you're detail-oriented, driven by problem-solving, and passionate about improving patient care on a broader scale, this is an excellent opportunity to take your nursing career in a new direction.
Qualifications you'll bring:- RN with current state licensure. BS in Nursing or Health Management is preferred.
- 3+ years strong clinical background required
- Excellent verbal and written communication abilities.
- Independent thought process; oriented toward probing/problem solving
Your key responsibilities: - Reviews inpatient medical records against established criteria and standards to determine medical appropriateness and level of care assignment.
- Review individual claims requiring clinical interpretation and judgment. Implements the operational functions of the MVP Utilization Management program as assigned.
- Potential to travel to designated locations to access medical information. Tracks on a regular basis the required care of individual members and advises providers of desired delivery options such as equipment vendors and home care agents.
- Collects and reviews care plans and progress reports to justify extension of service authorization.
- Reviews complex cases with individual providers or leader and the MVP Senior Medical Leaders.
- Knows and interprets the MVP contract, riders, policies and procedures.
Where you'll be: Location: Remote
Pay TransparencyMVP 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
