Medical Claims Reviewer – Remote

Join a growing SDVOSB and HUBZone-certified consulting company delivering innovative solutions for government and private sector clients. This role is ideal for experienced RNs with a background in medical review and utilization who want to contribute to meaningful work from home.


About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business focused on program management, technology, and consulting. We partner with clients to transform challenges into opportunities, delivering sustainable, tailored solutions built on integrity, collaboration, and excellence.


Schedule

  • Full-time (40 hours/week), Monday–Friday, 8:00 AM – 4:30 PM
  • Remote with high-speed internet and private office required
  • Occasional travel to Augusta, GA office (approx. 4 times per year)
  • Preference given to candidates in Georgia or South Carolina, and those living in HUBZone areas

What You’ll Do

  • Conduct medical reviews of claims across radiology, ambulance, physical therapy, surgical, and more
  • Determine coverage, necessity, and appropriate payment based on protocols and clinical guidelines
  • Document clinical rationale for approvals or denials
  • Provide education on medical terminology, coverage determinations, and coding practices
  • Support fraud/abuse detection and correct coding reviews
  • Mentor LPN team members and assist in staff education
  • Participate in quality control, special projects, and team-based initiatives

What You Need

  • Active, unrestricted RN license (compact multistate NLC accepted)
  • Bachelor’s degree in Nursing (required); Master’s preferred
  • 5+ years of clinical RN experience
  • 2+ years in utilization/medical review, quality assurance, or home health
  • Strong clinical background in home health, rehab, and/or medical-surgical nursing
  • Solid knowledge of managed care, protocols, and medical review processes
  • Strong communication, analytical, and decision-making skills
  • Proficiency with Microsoft Office and multitasking across multiple systems

Preferred Skills

  • 5+ years in medical review, quality assurance, or home health
  • Master’s degree in Nursing
  • Experience with HUBZone employment programs

Benefits

  • 401(k) with company match
  • Medical, dental, vision, life, and disability insurance
  • Flexible spending accounts
  • Paid time off and holidays
  • Remote work with required HUBZone participation

This is your chance to leverage your clinical expertise while contributing to a mission-driven small business making a difference in healthcare oversight.

Bring your nursing background and review expertise to Broadway Ventures.


Happy Hunting,
~Two Chicks…

APPLY HERE