Full-Time

Medical Review

Medicare

Posted on 9/9/2026

Broadway Ventures

Broadway Ventures

Compensation Overview

$62k - $65k/yr

Remote in USA

Remote

Bachelor's, Associate's

Category
Medical, Clinical & Veterinary
Required Skills
Microsoft Office
Excel/Numbers/Sheets
Requirements
  • An Associate Degree in Nursing or graduation from an accredited School of Nursing.
  • Two years of clinical experience.
  • Working knowledge of word processing software and Microsoft Office.
  • Active registered nurse licensure in the state hired or an active compact multistate registered nurse license under the Nurse Licensure Compact.
  • Ability to work independently, prioritize effectively, make sound decisions, exercise good judgment, handle confidential or sensitive information discreetly, and apply analytical or critical thinking skills.
  • Demonstrated customer service, organizational, oral communication, and written communication skills.
Responsibilities
  • Perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility services.
  • Conduct pre-claim review determinations.
  • Evaluate Additional Documentation Request responses.
  • Communicate determinations directly to providers.
  • Meet production expectations and strict contractual turnaround requirements.
Desired Qualifications
  • A Bachelor's degree in Nursing or graduation from an accredited School of Nursing.
  • At least three years of registered nurse clinical experience.
  • Knowledge of spreadsheet and database software, including Microsoft Excel and Access.
  • Knowledge of managed care and current health care delivery systems, with clinical experience in home health, rehabilitation, or broad medical-surgical practice.
  • Knowledge of Medicare and regulations, policies, instructions, provisions, home health, and medical-review system and processing procedures.
  • Knowledge of, or ability to learn, specific criteria and protocol sets and their application.
  • Ability to persuade, negotiate, or influence others.

Company Size

N/A

Company Stage

N/A

Total Funding

N/A

Headquarters

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Founded

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