Conduct clinical reviews for Medicare claims in a fully remote role supporting a major federal subcontract. If you’re an experienced RN with strong clinical judgment and utilization review expertise, this position lets you apply your skills in a structured, mission-driven environment.
About Broadway Ventures
Broadway Ventures delivers innovative consulting, program management, and technology solutions for government and commercial clients. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, they focus on operational excellence, collaboration, and sustainable growth. Their Medical Review team supports critical Medicare claims work with accuracy, professionalism, and integrity.
Schedule
- Full-time
- Monday–Friday, 8:00 AM to 4:30 PM
- Fully remote, with high-speed wired internet required
- Must travel to Augusta, GA approximately four times per year
- Candidates in Georgia or South Carolina preferred
- Must live within a HUBZone (strong preference)
What You’ll Do
- Review pre-pay and post-pay Medicare claims across multiple service types (radiology, ambulance, PT, surgical, and more)
- Assess medical necessity, appropriateness, and compliance using clinical guidelines and protocol sets
- Make reasonable charge determinations and document clinical rationale
- Support appeals and reconsideration requests
- Identify potential fraud, abuse, and coding issues
- Provide education to internal and external staff on medical terminology, review practices, and coverage determinations
- Participate in quality control activities and assist with special projects
- Offer guidance and support to LPN team members
What You Need
- Active, unrestricted RN license in the United States (compact multistate license required if applicable)
- Bachelor’s degree in Nursing required; Master’s preferred
- 5+ years of clinical RN experience (medical-surgical, home health, rehab, etc.)
- 2–3+ years in utilization review, medical review, home health, or quality assurance
- Strong knowledge of managed care delivery systems and clinical protocols
- Ability to work independently and make sound clinical decisions
- Proficiency with Microsoft Office and comfort using multiple systems/screens
- Excellent communication, documentation, and analytical skills
- Ability to handle confidential information with discretion
Benefits
- Health insurance
- Dental and vision coverage
- 401(k) with matching
- Paid time off
- Life insurance
- Disability insurance
- Flexible spending account
- Remote work with stable hours
This role is ideal for nurses who excel at clinical analysis, enjoy structured review work, and want remote stability without losing their clinical edge.
If you’re ready to bring your RN expertise to a highly specialized medical review team, this opportunity delivers challenge, purpose, and room to grow.
Happy Hunting,
~Two Chicks…