<div class="content-intro"><div class="et_pb_module et_pb_text et_pb_text_0 et_pb_text_align_left et_pb_bg_layout_light"> <div class="et_pb_text_inner"> <p style="text-align: justify;">At <strong>Broadway Ventures</strong>, 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.</p> </div> </div></div><p><strong>Registered nurse (RN) Medical Reviewer</strong></p> <p><strong>Location: </strong>Remote, U.S.</p> <p><strong>Type:</strong> Full-Time</p> <p><strong>Rate:</strong> $62-$65K</p> <p><strong>About Broadway Ventures</strong></p> <p>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.</p> <p><strong>Position summary</strong></p> <p>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.</p> <p><strong>Key Responsibilities: </strong></p> <ul> <li>Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.</li> <li>Assess payment determinations using clinical information and established guidelines.</li> <li>Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.</li> <li>Provide clear, well-documented rationales for service approvals or denials.</li> <li>Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.</li> <li>Support quality control activities to meet corporate and team objectives. Assist with special projects and additional responsibilities as assigned.</li> </ul> <p><strong>Minimum Qualifications</strong>:</p> <p><strong>Licensure</strong>:</p> <ul> <li>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).</li> </ul> <p><strong>Education</strong>:</p> <ul> <li>Associate Degree in Nursing OR Graduate of an accredited School of Nursing.</li> </ul> <p><strong>Experience</strong>:</p> <ul> <li>Minimum two years of clinical experience plus at least two years in one of the following: <ul> <li>Inpatient/Outpatient settings (i.e. medical-surgical, rehabilitation, SNF, etc..)</li> <li>Utilization/Medical Review Intensive care (ICU/ER)</li> <li>Quality Assurance Familiarity with Medicare Part A/B/HHH guidelines</li> </ul> </li> </ul> <p><strong>Skills & Competencies</strong>:</p> <ul> <li>Strong clinical background in managed care and/or inpatient/outpatient settings.</li> <li>Ability to interpret and apply medical review criteria and clinical guidelines.</li> <li>Proficiency in Microsoft Office and word processing software.</li> <li>Strong analytical, organizational, and decision-making skills.</li> <li>Ability to work independently while managing priorities effectively.</li> <li>Excellent customer service, communication, and critical thinking skills.</li> <li>Ability to handle confidential information with discretion.</li> </ul> <p><strong>Preferred Qualifications:</strong></p> <ul> <li>Three years of clinical nursing experience in Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance.</li> <li>Proficiency in using multiple screens and software programs simultaneously.</li> <li>Training and experience in ICD coding.</li> </ul> <p><strong>Remote & Logistics Requirements</strong></p> <ul> <li><strong>CMS Residency Rule</strong>: Must have lived in the United States for at least 3 out of the last 5 years to pass the required background check.</li> <li><strong>Infrastructure</strong>: A private home office with high-speed, hardwired internet (satellite, hot spots, or</li> <li><strong>Internet</strong>: Fiber internet. 5G satellite home internet is not permitted due to security protocols).</li> </ul> <p> </p><div class="content-conclusion"><p data-start="1731" data-end="1755">What to Expect Next:</p> <p data-start="1757" data-end="2185">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. Som