Concurrent Review RN

MVP Health Care is a nationally-recognized, regional not-for-profit health plan committed to having a positive impact on health and wellness of everyone we serve. With MVP, you are assured of quality health care and peace of mind—from a name you know and trust. We care for more than 700,000 members across New York and Vermont, creating healthier communities and continuing our 30-year legacy of quality and integrity.

Tracks and influences the services provided to MVP members as they move through the continuum of care. Reviews inpatient medical records against established criteria and standards to determine medical appropriateness and level of care assignment. May review individual claims requiring clinical interpretation and judgment. Implements the operational functions of the MVP Utilization Management program as assigned. Travels to designated location 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 supervisor/manager and the MVP Medical Directors. Knows and interprets the MVP contract, riders, policies and procedures. Perform other duties as assigned.

* Accuracy - Checks the accuracy of data received or generated before passing it on. Rarely makes obvious mistakes. Prepares and carefully reviews figures, computations, reports, etc. * Attention to Detail - Pays attention to details, checks for correctness. Keeps track of details to ensure work is performed accurately and completely. Focuses well, avoids distractions. * Communication - Provides clear, concise information to others in a variety of formats (verbal, written, electronic, etc.). Listens actively and empathetically to the views of others. Asks the appropriate questions to ensure that all relevant facts are considered before a decision is made or an action is initiated. Helps others consider new perspectives. Delivers critical information to all stakeholders/everyone involved. Seeks to clarify ambiguity. Utilizes communication technology. * Maintains Confidentiality - Preserves confidences. Evokes trust and candor during and after confidential discussions. Gets permission upfront to divulge private information. Shares information in discussions and negotiations to minimum necessary to achieve results. Abides by company and departmental regulations and confidentiality policies. * Follows Procedures - Understands and follows prescribed company and department policies and procedures, to assure outcomes meet defined objectives, even when it is inconvenient to do so. Identifies policies and procedures which interfere with productivity and makes recommendations for process improvement. * Information Gathering - Gathers necessary and appropriate information from a variety of sources, to clarify situations and to facilitate effective planning, decision-making, and problem solving. Records, summarizes, and creates representations of data. Probes skillfully to get the facts. Seeks the perspective of all stakeholders involved. Seeks out knowledgeable people to obtain information or clarify a problem. * Process Management - Understands, creates, and describes the processes necessary to get things done. Knows how to organize people and activities; understands how to separate and combine tasks into efficient work flow. Knows what to measure and how to measure it. Sees opportunities for synergy and integration where others can't. Simplifies complex processes; gets more out of fewer resources.

**Minimum Education:** * RN with current state licensure and 3+ years strong clinical background required. * BS in Nursing or Health Management is preferred. **Minimum Experience:** * Minimum of 1 year UM experience is preferred * Familiarity with National Criteria Standards is preferred **Required Skills:** * Excellent verbal and written communication abilities; * Independent thought process; oriented toward probing/problem solving * Working computer knowledge