Remote Registered Nurse – Medical Claims Reviewer

Overview

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team at Broadway Ventures, where we transform challenges into opportunities through expert program management and innovative consulting solutions.

In Short

• Full-time position (40 hours/week) with a Monday–Friday schedule.
• Remote work from home within the U.S.
• Conduct pre- and post-payment medical reviews for compliance.
• Assess medical necessity and reimbursement eligibility.
• Provide clear documentation for service approvals or denials.
• Educate teams on medical review processes and coding requirements.
• Support quality control activities and assist with special projects.
• Requires active RN license and clinical experience.
• Strong analytical and communication skills are essential.
• Equipment provided for effective job performance.

Requirements

• Active RN license in the U.S. or compact multistate RN license.
• Associate Degree in Nursing or graduate of an accredited School of Nursing.
• Two years of clinical experience, plus two years in Home Health, Utilization Review, or Quality Assurance.
• Strong clinical background in managed care or medical-surgical settings.
• Ability to interpret medical review criteria and clinical guidelines.
• Proficiency in Microsoft Office and word processing software.
• Excellent customer service and critical thinking skills.
• Ability to handle confidential information with discretion.

Benefits

• Work from home with flexible hours.
• Comprehensive training and support.
• Opportunity to impact healthcare quality and compliance.
• Access to necessary equipment and resources.
• Collaboration with a dedicated medical review team.