Use your clinical expertise to make a direct impact on healthcare outcomes. Broadway Ventures is seeking a Medical Claims Reviewer to join our team in support of Palmetto GBA. This is an excellent opportunity for an RN with strong utilization review or medical claims experience who thrives on accuracy, compliance, and patient-centered work.
About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) dedicated to transforming challenges into opportunities. We provide innovative consulting, program management, and technology solutions that help government and private clients achieve operational success and growth. Integrity, collaboration, and excellence guide everything we do.
Schedule
- Full-time, remote position
- Monday–Friday, 8:00 AM – 4:30 PM EST
- Must have high-speed internet (non-satellite) and a private home office
- Occasional travel to Augusta, GA office (approx. 4 times/year)
- Preference for candidates based in Georgia or South Carolina
- Applicants must live in or be willing to relocate to a HUBZone area (verify at SBA.gov)
What You’ll Do
- Perform medical reviews for claims across radiology, ambulance, physical therapy, and surgical services.
- Review pre-pay and post-pay claims, appeals, and potential fraud referrals.
- Apply clinical guidelines and protocol sets to determine medical necessity and coverage.
- Document and justify claim payment or denial decisions clearly.
- Educate internal teams and non-clinical staff on coverage determinations, terminology, and procedures.
- Participate in quality control activities and provide input for process improvements.
- Mentor LPN team members and support team education.
- Assist with special projects and audits as needed.
What You Need
- Active, unrestricted RN license (compact multistate preferred).
- Bachelor’s degree in Nursing required; Master’s degree strongly preferred.
- 5+ years of clinical RN experience.
- 3+ years in utilization review, quality assurance, or home health.
- Strong knowledge of managed care systems and medical/surgical practice areas.
- Working knowledge of clinical guidelines and coding procedures.
- Excellent judgment, communication, and organizational skills.
- Proficiency with Microsoft Office and ability to manage multiple systems/screens.
- Ability to handle confidential information with discretion.
Benefits
- Salary: $67,700 annually
- 401(k) with employer match
- Health, dental, vision, and life insurance
- Disability insurance and FSA options
- Paid time off and holidays
- Work-from-home flexibility
Bring your expertise to a mission-driven team where your work directly improves healthcare delivery.
Happy Hunting,
~Two Chicks…