Medical Reviewer (Remote)
Broadway Ventures · United States · remote
At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.
Registered nurse (RN) Medical Reviewer
Location: Remote, U.S.
Type: Full-Time
Rate: $62-$65K
About Broadway Ventures
Broadway Ventures is a veteran-owned small business (SDVOSB, HUBZone certified) headquartered in Vicksburg, Mississippi, delivering mission-critical support to federal health and defense customers. We hire people who bring clinical rigor, sound judgment, and a commitment to doing the work right.
Position summary
We are seeking an experienced Registered Nurse to perform medical review of complex claims, pre-authorization requests, appeals, and fraud and abuse referrals. In this role you will apply clinical expertise and established coverage guidelines to determine medical necessity and support accurate payment determinations.
Key Responsibilities:
- Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
- Assess payment determinations using clinical information and established guidelines.
- Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
- Provide clear, well-documented rationales for service approvals or denials.
- Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
- Support quality control activities to meet corporate and team objectives. Assist with special projects and additional responsibilities as assigned.
Minimum Qualifications:
Licensure:
- Active, unrestricted RN license in the U.S. and in the state of hire OR Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
- Associate Degree in Nursing OR Graduate of an accredited School of Nursing.
Experience:
- Minimum two years of clinical experience plus at least two years in one of the following:
- Inpatient/Outpatient settings (i.e. medical-surgical, rehabilitation, SNF, etc..)
- Utilization/Medical Review Intensive care (ICU/ER)
- Quality Assurance Familiarity with Medicare Part A/B/HHH guidelines
Skills & Competencies:
- Strong clinical background in managed care and/or inpatient/outpatient settings.
- Ability to interpret and apply medical review criteria and clinical guidelines.
- Proficiency in Microsoft Office and word processing software.
- Strong analytical, organizational, and decision-making skills.
- Ability to work independently while managing priorities effectively.
- Excellent customer service, communication, and critical thinking skills.
- Ability to handle confidential information with discretion.
Preferred Qualifications:
- Three years of clinical nursing experience in Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance.
- Proficiency in using multiple screens and software programs simultaneously.
- Training and experience in ICD coding.
Remote & Logistics Requirements
- CMS Residency Rule: Must have lived in the United States for at least 3 out of the last 5 years to pass the required background check.
- Infrastructure: A private home office with high-speed, hardwired internet (satellite, hot spots, or
- Internet: Fiber internet. 5G satellite home internet is not permitted due to security protocols).
What to Expect Next:
After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.
Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.
Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).
The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.
Location Eligibility: Broadway Ventures cannot consider applicants who live in, or would work from, any of the following locations: California, Colorado, Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, Washington State, and Wyoming. Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed. Applications from residents of the locations listed above will not be considered.
Notice: Use of Artificial Intelligence in Our Hiring Process
Broadway Ventures uses an artificial intelligence (AI) tool to help review applications for this position.
- Who built it: Broadway Ventures developed the tool in-house.
- What it does: It compares your resume to the requirements in this job posting and gives a score from 0 to 100 showing how closely your qualifications match.
- What information it uses: The text of your resume, your name, your current or most recent job title, your location, and this job posting.
- What it cannot see: Your answers to voluntary demographic or equal employment opportunity questions, interview feedback, or offer information.
- How it is used: The score is one factor in our initial review of applications. The tool does not reject anyone. A member of our recruiting team reviews every application before any decision is made.
- Your options: If you would like your application reviewed without the AI tool, or you need a reasonable accommodation at any point in the hiring process, contact us at recruiting@broadwayventures.net. Making a request will not affect whether you are considered for this position.
Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.
Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.
- 401(k) and company match
- PTO that grows the longer you stay
- Health, Vision, Dental
- Company provided Life Insurance and Voluntary Life Insurance
- Short Term Disability and Long Term Disability