Broadway Ventures, LLC

Remote Home Health RN – Medical Claims Reviewer

United States - Remote · Staff+ · Contract

Sponsorship not specified$60k-$63kDetected 7 days ago

Customer SupportCommunicationCollaborationCritical ThinkingMicrosoft Office

About the role

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team.
This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.

Support quality control activities to meet corporate and team objectives.
Provide guidance to LPN team members and support non-clinical staff through training and discussions.
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.

Proficiency in using multiple screens and software programs simultaneously.
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.

Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical 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.

Home Health (meets for both clinical and HH requirement for a total of 2 years)
Utilization/Medical Review
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
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.
Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions.

This listing is sourced directly from Broadway Ventures, LLC's careers page and normalized into a canonical job model.