RemoteMust live and work in an eligible U.S. state; California, Colorado, Connecticut, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, Washington, and Wyoming are excluded.
Medical, Clinical & Veterinary
About the job
Requirements
All RN Medical Reviewers must possess an active, unrestricted registered nurse license in their state of residence.
A minimum of 2 years of clinical experience is required, along with at least 2 years of experience in home health, quality assurance, or utilization review.
Responsibilities
Conduct comprehensive reviews of home health pre-claim review packages to determine compliance with Medicare coverage, coding, and payment criteria.
Document affirmation or non-affirmation review outcomes with clinical rationale in the designated case management system, meeting a turnaround time of within 7 business days.
Engage with providers, as authorized, to request or clarify documentation, and escalate provider concerns or suspected fraud according to established program procedures.
Maintain 98% accuracy and complete required training, quality assurance reviews, and inter-rater reliability sessions.
Desired Qualifications
Experience in home health, including OASIS and Medicare Conditions of Participation, or prior involvement with MAC, RCD, or CMS program integrity.
Proficiency in ICD coding.
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.
Compensation rate: $65K annual
Start Date: December 2026
Key Responsibilities:
Conduct comprehensive reviews of home health pre-claim review (PCR) packages to determine compliance with Medicare coverage, coding, and payment criteria.
Document review outcomes (affirmation/non-affirmation) with well-defined clinical rationale in the designated case management system, ensuring a turnaround time of within 7 business days.
Engage with providers, as authorized, to request or clarify documentation, and escalate any provider concerns or suspected fraud in accordance with established program procedures.
Maintain a standard of 98% accuracy and fulfill all required training, quality assurance reviews, and inter-rater reliability sessions.
Minimum Qualifications:
All RN Medical Reviewers must possess the following minimum qualifications: an active, unrestricted RN license in their state of residence.
A minimum of 2 years of clinical experience, along with at least 2 years of experience in home health, quality assurance, or utilization review.
Preferred Qualifications:
Experience in home health (OASIS, Medicare Conditions of Participation) or prior involvement with MAC/RCD/CMS program integrity.
Proficiency in ICD coding.
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 [email protected]. 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