Medical Underwriting Nurse

At 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 Medical Underwriting Nurse to join #TeamMVP. This is the opportunity for you if you have a passion for expanding your scope of knowledge and being the difference. 

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:

• Active Registered Nurse (RN) license. Bachelor’s degree in Nursing, Health Administration, or a related field preferred

• Minimum of 4 – 6+ years of professional relevant work experience, requires a minimum of two (2) years of clinical experience

• Knowledge of ICD 10 coding and medical terminology

• Strong understanding of medical conditions, treatments, and their long-term impact on health and insurability.

• Requires understanding of disease life cycle, disease progression, expected health outcomes based on standard, accepted care management principles.

• Requires understanding of health and prescription costs.

• Understanding of risk mitigation, high claimant detection, engagement and management preferred 

• 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:

• Analyze medical and pharmacy utilization reports to assist underwriting in predicting future claim costs.

• Collaborate with healthcare providers and insurance teams to gather additional medical information as needed.

• Works with the underwriting team to evaluate risks and opportunities in new business and renewal groups, and to assess patient clinical needs against established guidelines, ensuring care levels are medically necessary and appropriate

• Use knowledge of medical terminology, conditions, treatments, and outcomes to assist in making informed underwriting decisions

• Make recommendations based on analysis and review; providing clinical, medical review, and expertise for cost of care; referring further follow up to Clinical Review or other teams as needed. 

• When appropriate, works with the Care Management team to ensure claimants are engaged in care management protocols

• Stay current with medical advancements and health trends that could impact underwriting processes.

• Provide consultation and guidance to internal and external clients on complex medical cases.

• Work with internal teams to ensure the most effective care plan is put in place to mitigate risk and meet clinical needs for the predicted prognosis.

• Provide clinical opinion from analysis and experience to underwriters as requested or deemed appropriate.

• 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:

Hybrid - Schenectady, NY

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. 
 
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.