Bring your clinical expertise to a team making a direct impact on healthcare quality. As a Medical Claims Reviewer with Broadway Ventures, you’ll handle complex claims and ensure accurate, fair outcomes—all while working from home.
About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB). We specialize in program management, technology, and consulting that help clients across government and private sectors thrive. Our work is built on integrity, collaboration, and innovation.
Schedule
- Full-time, Monday–Friday, 8:00 AM to 4:30 PM EST
- Remote work (must maintain a private home office with high-speed internet)
- Occasional travel (about 4x/year) to Augusta, GA
- Preference given to applicants living in South Carolina or Georgia, and within a HUBZone
What You’ll Do
- Perform medical reviews for pre-pay and post-pay claims across multiple specialties (radiology, ambulance, physical therapy, surgical).
- Determine medical necessity, appropriateness, and reimbursement accuracy.
- Document medical rationale for claim approvals or denials.
- Provide guidance to staff, educate non-medical teams, and support audits.
- Mentor LPN team members and contribute to continuous process improvement.
What You Need
- Active, unrestricted RN license (compact multistate license preferred).
- Bachelor’s degree in Nursing (Master’s preferred).
- 5+ years of clinical nursing experience; at least 2 years in utilization review, quality assurance, or home health.
- Strong knowledge of managed care systems, coding protocols, and clinical guidelines.
- Proficiency in Microsoft Office; ability to prioritize and work independently.
Benefits
- 401(k) with employer match
- Health, dental, and vision insurance
- Life and disability insurance
- Flexible spending account
- Paid time off and holidays
- Work-from-home flexibility
Advance your nursing career while improving healthcare outcomes.
Make your expertise count—apply today.
Happy Hunting,
~Two Chicks…