Bring your RN expertise to a mission-driven, fully remote role reviewing complex medical claims for accuracy, compliance, and quality care decisions.
About Broadway Ventures
Broadway Ventures is an 8(a), HUBZone, Service-Disabled Veteran-Owned Small Business (SDVOSB) that supports government and private sector clients with program management, technology, and consulting solutions. The team partners on high-impact initiatives like the World Trade Center Health Program, combining integrity, innovation, and operational excellence to improve how healthcare services are delivered and paid.
Schedule
- Remote, work-from-home
- Monday–Friday
- 8:00 AM – 4:30 PM (EST)
- Must live within a three-hour driving radius of Augusta, GA
- Must have a private, lockable home office and high-speed, hardwired internet
- Occasional travel to Augusta, GA office (around four times per year)
Responsibilities
- Conduct pre-pay and post-pay medical claim reviews for services such as radiology, ambulance, physical therapy, and surgery
- Review medically complex claims, preauthorization requests, appeals, and potential fraud/abuse cases using established criteria and clinical guidelines
- Determine medical necessity, reasonableness, and coverage for services and supplies
- Document clear medical rationales for payment, partial payment, or denial decisions
- Apply correct coding practices and program policies during claims adjudication
- Educate internal and external stakeholders on medical reviews, terminology, coverage decisions, and coding practices
- Support quality control efforts and contribute to team-based performance goals
- Provide guidance to LPN team members and education to non-clinical staff
- Assist with special projects, audits, and process improvement initiatives
Requirements
- Education & Licensure
- Bachelor’s degree in Nursing (BSN) from an accredited School of Nursing (required)
- Active, unrestricted RN license in the United States and state of hire (required)
- Compact multistate RN license under the Nurse Licensure Compact (NLC) strongly preferred
- Master’s degree in Nursing or related field preferred
- Experience
- Minimum 5 years of clinical RN experience (e.g., med-surg, home health, rehab, or broad medical-surgical)
- At least 2–3 years in utilization/medical review, quality assurance, or home health
- Strong background in managed care and healthcare delivery systems
- Prior experience with medical claim review and coverage determinations
- Skills & Knowledge
- Working knowledge of clinical criteria/protocol sets and how to apply them
- Strong analytical, critical thinking, and decision-making skills
- Excellent written and verbal communication; able to educate and influence others
- Ability to work independently, prioritize workload, and meet deadlines
- High level of discretion with confidential and sensitive information
- Proficient with Microsoft Office and comfortable using multiple systems/screens
- Logistics
- Live within a HUBZone or be willing to confirm HUBZone eligibility (strongly preferred)
- Live within a three-hour driving radius of Augusta, GA
- Authorized to work in the United States
- Reliable high-speed internet with ethernet capability
Benefits
- 401(k) with employer matching
- Health, dental, and vision insurance
- Life and disability insurance
- Flexible Spending Account (FSA)
- Paid time off and paid holidays
- Fully remote work with occasional on-site visits
Ready to use your RN experience in a stable, remote medical review role that still makes a real impact on patient care and program integrity?
Happy Hunting,
~Two Chicks…