Join a mission-driven team at Broadway Ventures and use your clinical expertise to ensure accuracy, compliance, and quality in medical claims review. This role allows you to make a meaningful impact on patient outcomes while working fully remote with company-provided equipment.
About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB). We deliver tailored program management, consulting, and technology solutions to government and private sector clients. Built on integrity, collaboration, and excellence, we turn challenges into opportunities and act as a trusted partner in innovation.
Schedule
- Full-time, 40 hours per week
- Monday–Friday, 8:00 AM – 5:00 PM EST
- Remote (U.S. – work from home)
- Requirements: high-speed internet (non-satellite) and a private, lockable home office
- Equipment provided: desktop computer, dual monitors, headset, ethernet cable, and accessories
What You’ll Do
- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals
- Assess medical necessity, appropriateness, and reimbursement eligibility using clinical guidelines
- Document decisions clearly and in compliance with regulatory standards
- Provide education on medical review processes, coverage determinations, and coding requirements
- Support quality control initiatives and corporate objectives
- Provide guidance to LPNs and assist non-clinical staff as needed
- Contribute to special projects and additional responsibilities as assigned
What You Need
- Active, unrestricted RN license in the U.S. (or compact multistate license)
- Associate Degree in Nursing or graduation from an accredited School of Nursing
- Minimum 2 years of clinical experience plus 2 years in home health, utilization/medical review, or quality assurance
- Strong background in managed care, rehabilitation, or medical-surgical nursing
- Ability to interpret and apply medical review criteria and clinical guidelines
- Skilled in Microsoft Office and electronic documentation
- Strong analytical, organizational, and decision-making abilities
- Excellent communication and customer service skills
Preferred Qualifications
- 3+ years of experience in Home Health, Utilization Review, or Medical Review
- Proficiency with multiple screens and software programs simultaneously
Benefits
- 401(k) with employer match
- Health, dental, and vision insurance
- Life insurance
- Flexible Paid Time Off (PTO)
- Paid holidays
- Company-provided technology setup
Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor. We value diversity, celebrate unique perspectives, and provide accommodations for applicants with disabilities.
If you’re a detail-oriented RN passionate about medical review, we encourage you to apply today.
Happy Hunting,
~Two Chicks…