[Hiring] Medical Reviewer II @Broadway Ventures

Role Description

Broadway Ventures is seeking a licensed Registered Nurse to perform complex medical review of Medicare claims for Inpatient Rehabilitation Facility (IRF) services. This role conducts pre-claim review (PCR) determinations, evaluates Additional Documentation Request (ADR) responses, and communicates determinations directly to providers. Work is production-driven and governed by strict contractual turnaround requirements.

Qualifications

• Associate Degree – Nursing, or Graduate of an accredited School of Nursing
• 2 years clinical experience
• Working knowledge of word processing software
• Ability to work independently, prioritize effectively, and make sound decisions
• Good judgment skills
• Demonstrated customer service and organizational skills
• Demonstrated oral and written communication skills
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion
• Active RN licensure in state hired, OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)

Requirements

• Bachelor's degree – Nursing, OR Graduate of an Accredited School of Nursing (preferred)
• Preferred experience minimum 3 years RN clinical experience
• Knowledge of spreadsheet and database software (preferred)
• Ability to persuade, negotiate, or influence others (preferred)
• Working knowledge of managed care and various current forms of health care delivery systems; strong clinical experience — home health, rehabilitation, and/or broad medical surgical experience (preferred)
• Knowledge of Medicare and/or regulations/policies/instructions/provisions, home health, system/processing procedures for medical review (preferred)
• Knowledge of or ability to learn specific criteria/protocol sets and the use of the same (preferred)
• Working knowledge of Microsoft Excel, Access, or other spreadsheet/database software (preferred)

Benefits

• 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